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Transvalvular flow, sex, and survival after valve replacement surgery in patients with severe aortic stenosis

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bul.description.provenancelf spb autorité-manquante : Zhang (XX5115980)fr
bul.rights.dateAccepPubl2020-04-28fr
bul.rights.periodeEmbargoP0Mfr
bul.rights.typeDatedatePublicationfr
dc.contributor.authorBilodeau, Anthony
dc.contributor.authorGuzzetti, Ezequiel
dc.contributor.authorKalavrouziotis, Dimitri
dc.contributor.authorZhang, Bin
dc.contributor.authorCouture, Christian
dc.contributor.authorAnnabi, Mohamed Salah
dc.contributor.authorPibarot, Philippe
dc.contributor.authorClavel, Marie-Annick
dc.contributor.authorDagenais, François.
dc.date.accessioned2020-06-30T14:26:56Z
dc.date.available2020-06-30T14:26:56Z
dc.date.issued2020-04-28
dc.description.abstractBackground : 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.doi10.1016/j.jacc.2020.02.065fr
dc.identifier.issn0735-1097fr
dc.identifier.pubmed32327100fr
dc.identifier.urihttp://hdl.handle.net/20.500.11794/39628
dc.languageengfr
dc.publisherElsevierfr
dc.rightshttp://purl.org/coar/access_right/c_abf2
dc.subjectCalcific aortic stenosisfr
dc.subjectParadoxical low flowfr
dc.subjectSex differencesfr
dc.subjectSurgical aortic valve replacementfr
dc.subjectSurvivalfr
dc.subject.rvmAorte -- Rétrécissementfr
dc.subject.rvmValve aortique -- Calcificationfr
dc.subject.rvmHémodynamiquefr
dc.subject.rvmDifférences entre sexesfr
dc.subject.rvmProthèses valvulaires cardiaquesfr
dc.subject.rvmCœur -- Valvules -- Chirurgiefr
dc.subject.rvmPronostics (Pathologie)fr
dc.titleTransvalvular flow, sex, and survival after valve replacement surgery in patients with severe aortic stenosisfr
dc.title.alternativeImpact of sex and flow after surgical AVRfr
dc.typearticle de recherche
dc.type.legacyCOAR1_1::Texte::Périodique::Revue::Contribution à un journal::Article::Article de recherchefr
dcterms.bibliographicCitationJournal of the American College of Cardiology, Vol. 75 (16), 1897-1909 (2020)fr
dspace.accessstatus.time2023-01-28 18:01:32
dspace.entity.typePublication
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rioxxterms.project.funder-nameEdwards Lifesciencesfr
rioxxterms.project.funder-nameMedtronicfr
rioxxterms.versionAMfr
rioxxterms.version-of-recordhttps://doi.org/10.1016/j.jacc.2020.02.065fr
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