Outcome and impact of aortic valve replacement in patients with preserved LVEF and low-gradient aortic stenosis

Authors: Dayan, Victor; Vignolo, Gustavo; Magne, JulienClavel, Marie-Annick; Mohty, Dania; Pibarot, Philippe
Abstract: Background : Low mean transvalvular gradient (<40 mm Hg) and small aortic valve area (<1.0 cm2) in patients with aortic stenosis (AS) and preserved left ventricular ejection fraction raises uncertainty about the actual severity of the stenosis and survival benefit of aortic valve replacement (AVR). Objectives : This study analyzed studies of mortality and survival impact of AVR in patients with low-gradient (LG) AS and preserved left ventricular ejection fraction, including paradoxical low-flow (i.e., stroke volume index <35 ml/m2), low-gradient (LF-LG) and normal-flow, low-gradient (NF-LG), and those with high-gradient (=40 mm Hg) AS or moderate AS. Methods : Studies published between 2005 and 2015 were analyzed. Primary outcome was the survival benefit associated with AVR. Secondary outcome was overall mortality regardless of treatment. Results : Eighteen studies were included in the analysis. Patients with LF-LG AS have increased mortality compared with patients with moderate AS (hazard ratio [HR]: 1.68; 95% confidence interval [CI]: 1.31 to 2.17), NF-LG (HR: 1.80; 95% CI: 1.29 to 2.51), and high-gradient (HR: 1.67; 95% CI: 1.16 to 2.39) AS. AVR was associated with reduced mortality in patients with LF-LG (HR: 0.44; 95% CI: 0.25 to 0.77). Similar benefit occurred with AVR in patients with NF-LG (HR: 0.48; 95% CI: 0.28 to 0.83). Compared with patients with high-gradient AS, those with LF-LG were less likely to be referred to AVR (odds ratio: 0.32; 95% CI: 0.21 to 0.49). Conclusions : Patients with paradoxical LF-LG AS and NF-LG AS have increased risk of mortality compared with other subtypes of AS with preserved left ventricular ejection fraction, and improved outcome with AVR.
Document Type: Article de recherche
Issue Date: 15 December 2015
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/4768
This document was published in: Journal of the American College of Cardiology, Vol. 66 (23), 2594–2603 (2015)
Elsevier Biomedical
Alternative version: 10.1016/j.jacc.2015.09.076
Collection:Articles publiés dans des revues avec comité de lecture

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