Publication : Transvalvular flow, sex, and survival after valve replacement surgery in patients with severe aortic stenosis
bul.description.provenance | lf spb autorité-manquante : Zhang (XX5115980) | fr |
bul.rights.dateAccepPubl | 2020-04-28 | fr |
bul.rights.periodeEmbargo | P0M | fr |
bul.rights.typeDate | datePublication | fr |
dc.contributor.author | Bilodeau, Anthony | |
dc.contributor.author | Guzzetti, Ezequiel | |
dc.contributor.author | Kalavrouziotis, Dimitri | |
dc.contributor.author | Zhang, Bin | |
dc.contributor.author | Couture, Christian | |
dc.contributor.author | Annabi, Mohamed Salah | |
dc.contributor.author | Pibarot, Philippe | |
dc.contributor.author | Clavel, Marie-Annick | |
dc.contributor.author | Dagenais, François. | |
dc.date.accessioned | 2020-06-30T14:26:56Z | |
dc.date.available | 2020-06-30T14:26:56Z | |
dc.date.issued | 2020-04-28 | |
dc.description.abstract | Background : The respective impacts of transvalvular flow, gradient, sex, and their interactions on mortality in patients with severe aortic stenosis undergoing surgical aortic valve replacement (AVR) are unknown. Objectives : This study sought to compare the impact of pre-operative flow-gradient patterns on mortality after AVR and to examine whether there are sex differences. Methods : This study analyzed clinical, echocardiographic, and outcome data prospectively collected in 1,490 patients (544 women [37%]), with severe aortic stenosis and preserved left ventricular ejection fraction who underwent AVR. Results : In this cohort, 601 patients (40%) had normal flow (NF) with high gradient (HG), 405 (27%) NF with low gradient (LG), 246 (17%) paradoxical low flow (LF)/HG, and 238 (16%) LF/LG. During a median follow-up of 2.42 years (interquartile range: 1.04 to 4.29 years), 167 patients died. Patients with LF/HG exhibited the highest mortality after AVR (hazard ratio [HR]: 2.01; 95% confidence interval [CI]: 1.33 to 3.03; p < 0.01), which remained significant after multivariate adjustment (HR: 1.96; 95% CI: 1.29 to 2.98; p < 0.01). Both LF/LG and NF/LG patients had comparable outcome to NF/HG (p ≥ 0.47). Optimal thresholds of stroke volume index were obtained for men (40 ml/m2) and women (32 ml/m2). Using these sex-specific cutpoints, paradoxical LF was independently associated with increased mortality in both women (adjusted HR: 2.05; 95% CI: 1.21 to 3.47; p < 0.01) and men (adjusted HR: 1.54; 95% CI: 1.02 to 2.32; p = 0.042), whereas guidelines’ threshold (35 ml/m2) does not. Conclusions : Paradoxical LF/HG was associated with higher mortality following AVR, suggesting that a reduced flow is a marker of disease severity even in patients with HG aortic stenosis. Early surgical AVR (i.e., before gradient attains 40 mm Hg) might be preferable in these patients. Furthermore, the use of sex-specific thresholds (<40 ml/m2 for men and <32 ml/m2 for women) to define low-flow outperforms the guidelines’ threshold of 35 ml/m2 in risk stratification after AVR. | fr |
dc.identifier.doi | 10.1016/j.jacc.2020.02.065 | fr |
dc.identifier.issn | 0735-1097 | fr |
dc.identifier.pubmed | 32327100 | fr |
dc.identifier.uri | http://hdl.handle.net/20.500.11794/39628 | |
dc.language | eng | fr |
dc.publisher | Elsevier | fr |
dc.rights | http://purl.org/coar/access_right/c_abf2 | |
dc.subject | Calcific aortic stenosis | fr |
dc.subject | Paradoxical low flow | fr |
dc.subject | Sex differences | fr |
dc.subject | Surgical aortic valve replacement | fr |
dc.subject | Survival | fr |
dc.subject.rvm | Aorte -- Rétrécissement | fr |
dc.subject.rvm | Valve aortique -- Calcification | fr |
dc.subject.rvm | Hémodynamique | fr |
dc.subject.rvm | Différences entre sexes | fr |
dc.subject.rvm | Prothèses valvulaires cardiaques | fr |
dc.subject.rvm | Cœur -- Valvules -- Chirurgie | fr |
dc.subject.rvm | Pronostics (Pathologie) | fr |
dc.title | Transvalvular flow, sex, and survival after valve replacement surgery in patients with severe aortic stenosis | fr |
dc.title.alternative | Impact of sex and flow after surgical AVR | fr |
dc.type | article de recherche | |
dc.type.legacy | COAR1_1::Texte::Périodique::Revue::Contribution à un journal::Article::Article de recherche | fr |
dcterms.bibliographicCitation | Journal of the American College of Cardiology, Vol. 75 (16), 1897-1909 (2020) | fr |
dspace.accessstatus.time | 2023-01-28 18:01:32 | |
dspace.entity.type | Publication | |
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rioxxterms.project.funder-name | Edwards Lifesciences | fr |
rioxxterms.project.funder-name | Medtronic | fr |
rioxxterms.version | AM | fr |
rioxxterms.version-of-record | https://doi.org/10.1016/j.jacc.2020.02.065 | fr |
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