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Prevalence and Prognostic Implications of Discordant Grading and Flow-Gradient Patterns in Moderate Aortic Stenosis




Julkaisun tekijätStassen Jan, Ewe See Hooi, Singh GurpreetK, Butcher Steele C, Hirasawa Kensuke, Amanullah Mohammed R, Pio Stephan M, Sin Kenny YK, Ding Zee P, Sia Ching-Hui, Chew Nicholas WS, Kong William KF, Poh Kian Keong, Leon Martin B, Pibarot Philippe, Delgado Victoria, Marsan Nina Ajmone, Bax Jeroen J

KustantajaElsevier Inc

Julkaisuvuosi2022

JournalJournal of the American College of Cardiology

Tietokannassa oleva lehden nimiJournal of the American College of Cardiology

Volyymi80

Julkaisunumero7

Aloitussivu666

Lopetussivun numero676

eISSN1558-3597

DOIhttp://dx.doi.org/10.1016/j.jacc.2022.05.036

Verkko-osoitehttps://doi.org/10.1016/j.jacc.2022.05.036


Tiivistelmä

BACKGROUND The prognostic implications of discordant grading in severe aortic stenosis (AS) are well known. However, the prevalence of different flow-gradient patterns and their prognostic implications in moderate AS are unknown.

OBJECTIVES The purpose of this study was to investigate the occurrence and prognostic implications of different flow-gradient patterns in patients with moderate AS.

METHODS Patients with moderate AS (aortic valve area >1.0 and #1.5 cm2) were identified and divided in 4 groups based on transvalvular mean gradient (MG), stroke volume index (SVi), and left ventricular ejection fraction (LVEF): concordant moderate AS (MG $20 mm Hg) and discordant moderate AS including 3 subgroups: normal-flow, low-gradient moderate AS (MG <20 mm Hg, SVi $35 mL/m2, and LVEF $50%); “paradoxical” low-flow, low-gradient moderate AS (MG <20 mm Hg, SVi <35 mL/m2, and LVEF $50%) and “classical” low-flow, low-gradient moderate AS (MG <20 mm Hg and LVEF <50%). The primary endpoint was all-cause mortality.

RESULTS Of 1,974 patients (age 73 10 years, 51% men) with moderate AS, 788 (40%) had discordant grading, and these patients showed significantly higher mortality rates than patients with concordant moderate AS (P < 0.001). On multivariable analysis, “paradoxical” low-flow, low-gradient (HR: 1.458; 95% CI: 1.072-1.983; P ¼ 0.014) and “classical” low-flow, low-gradient (HR: 1.710; 95% CI: 1.270-2.303; P < 0.001) patterns but not the normal-flow, low-gradient moderate AS pattern were independently associated with all-cause mortality.

CONCLUSIONS Discordant grading is frequently (40%) observed in patients with moderate AS. Low-flow, low- gradient patterns account for an important proportion of the discordant cases and are associated with increased mortality. These findings underline the need for better phenotyping patients with discordant moderate AS.


Last updated on 2023-15-06 at 16:13