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Management of aortic valve replacement according to the Gradient across symptomatic aortic valve stenosis and its prognostic impact

Abstract : Background - Treatment strategy for low-gradient (LG) aortic stenosis (AS) remains an unresolved issue. The presence of a low aortic gradient and preserved left ventricular ejection fraction (LVEF) might lead toward the underestimation of aortic stenosis severity and a more conservative management. We sought (a) to describe the nature and timing of intervention according to flow/gradient subgroups in patibents with LG-AS, (2) to determine the factors associated with the decision to intervene, and (c) to describe prognosis. Methods and results - One hundred and ten patients prospectively included in this study underwent a standardized clinical and imaging evaluation at inclusion and at 1-year follow-up. According to aortic flow, gradient and LVEF, patients were divided into 4 groups: LG-normal flow [n = 27], LG-low flow-low LVEF [n = 27], LG-low flow-normal LVEF [n = 16], and high gradient (HG) [n = 40]). 73% of patients underwent AVR 86 ± 59 days after the initial assessment. The HG subgroup had significantly higher intervention rates (P < .001). In multivariable analysis, four parameters were associated with the AVR: aortic gradient (HR 1.52 [1.10-2.11], P = .012), LVEF (HR 0.58 [0.40-0.85], P = .006), atrial fibrillation (HR 0.43 [0.021-0.87], P = .019), and NT-proBNP (HR 0.92[0.86-0.98), P = .008]. Patients operated earlier had better outcomes than those having a delayed AVR (P = .042). LG-AS patients had worse outcomes than HG-AS patients (P < .001). Conclusion - Compared to HG-AS, LG-AS is less likely to benefit from an AVR and had a significantly worse outcome. Further interventional studies are needed to investigate the timing of AVR in these patients.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-02364099
Contributor : Laurent Jonchère <>
Submitted on : Thursday, November 14, 2019 - 4:53:56 PM
Last modification on : Thursday, June 18, 2020 - 9:29:12 AM

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Valentin Bridonneau, Elena Galli, Vincent Auffret, Mathieu Lederlin, Marine Campion, et al.. Management of aortic valve replacement according to the Gradient across symptomatic aortic valve stenosis and its prognostic impact. Echocardiography, Wiley, 2019, 36 (12), pp.2136-2144. ⟨10.1111/echo.14531⟩. ⟨hal-02364099⟩

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