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oai:repisalud.isciii.es:20.500.12105/235022024-11-29T05:02:16Zcom_20.500.12105_15322com_20.500.12105_2051col_20.500.12105_16967

00925njm 22002777a 4500 dc Galian Gay, Laura author Escalona Silva, Roxana Andreina author Teixidó-Turà, Gisela author Casas, Guillem author Ferrer-Sistach, Elena author Mitroi, Cristina author Mingo, Susana author Monivas, Vanessa author Saura, Daniel author Vidal, Bàrbara author Trasca, Livia author Moral, Sergio author Calvo, Francisco author Castiñeira Busto, Maria author Sánchez, Violeta author Gonzalez, Ariana author Guzman, Gabriela author Noris Mora, Marta author Arnau Vives, MiguelÁngel author Peteiro, Jesús author Bouzas, Alberto author Mas-Stachurska, Aleksandra author González-Alujas, Teresa author Gutiérrez, Laura author Fernandez-Galera, Rubén author Valente, Filipa author Guala, Andrea author Ruiz-Muñoz, Aroa author Avilés, Cesar Augusto Sao author Rodríguez-Palomares, José F author Ferreira, Ignacio author Evangelista, Arturo author 2022 Objectives: To determine the risk of mortality and need for aortic valve replacement (AVR) in patients with low-flow low-gradient (LFLG) aortic stenosis (AS). Methods: A longitudinal multicentre study including consecutive patients with severe AS (aortic valve area [AVA] < 1.0 cm2) and normal left ventricular ejection fraction (LVEF). Patients were classified as: high-gradient (HG, mean gradient ≥ 40 mmHg), normal-flow low-gradient (NFLG, mean gradient < 40 mmHg, indexed systolic volume (SVi) > 35 ml/m2) and LFLG (mean gradient < 40 mmHg, SVi ≤ 35 ml/m2). Results: Of 1,391 patients, 147 (10.5%) had LFLG, 752 (54.1%) HG, and 492 (35.4%) NFLG. Echocardiographic parameters of the LFLG group showed similar AVA to the HG group but with less severity in the dimensionless index, calcification, and hypertrophy. The HG group required AVR earlier than NFLG (p < 0.001) and LFLG (p < 0.001), with no differences between LFLG and NFLG groups (p = 0.358). Overall mortality was 27.7% (CI 95% 25.3-30.1) with no differences among groups (p = 0.319). The impact of AVR in terms of overall mortality reduction was observed the most in patients with HG (hazard ratio [HR]: 0.17; 95% CI: 0.12-0.23; p < 0.001), followed by patients with LFLG (HR: 0.25; 95% CI: 0.13-0.49; p < 0.001), and finally patients with NFLG (HR: 0.29; 95% CI: 0.20-0.44; p < 0.001), with a risk reduction of 84, 75, and 71%, respectively. Conclusions: Paradoxical LFLG AS affects 10.5% of severe AS, and has a lower need for AVR than the HG group and similar to the NFLG group, with no differences in mortality. AVR had a lower impact on LFLG AS compared with HG AS. Therefore, the findings of the present study showed LFLG AS to have an intermediate clinical risk profile between the HG and NFHG groups. Galian-Gay L, Escalona Silva RA, Teixidó-Turà G, Casas G, Ferrer-Sistach E, Mitroi C, et al. Prognosis of Paradoxical Low-Flow Low-Gradient Aortic Stenosis: A Severe, Non-critical Form, With Surgical Treatment Benefits. Front Cardiovasc Med. 2022 Apr 1;9. 2297-055X http://hdl.handle.net/20.500.13003/18082 https://hdl.handle.net/20.500.12105/23502 35433871 10.3389/fcvm.2022.852954 Frontiers in cardiovascular medicine 806264400001 Prognosis of Paradoxical Low-Flow Low-Gradient Aortic Stenosis: A Severe, Non-critical Form, With Surgical Treatment Benefits