Department of Medicine.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
J Cardiovasc Med (Hagerstown). 2021 Jun 1;22(6):486-491. doi: 10.2459/JCM.0000000000001139.
In paradoxical low-flow low-gradient severe aortic stenosis (PLFLG AS) patients, stroke volume index (SVI) is reduced despite preserved left ventricular ejection fraction (LVEF). Although reduced SVI is already known as a poor prognostic predictor, the outcomes of PLFLG AS patients after transcatheter aortic valve replacement (TAVR) have not been clearly defined. We retrospectively investigated the post-TAVR outcomes of PLFLG AS patients in comparison with normal-flow high-gradient aortic stenosis (NFHG AS) patients.
The current observational study included 245 patients with NFHG AS (mean transaortic pressure gradient ≥40 mmHg and LVEF ≥ 50%) and 48 patients with PLFLG AS (mean transaortic pressure gradient <40 mmHg, LVEF ≥ 50% and SVI < 35 ml/m2). The endpoints were all-cause mortality, hospitalization for valve-related symptoms or worsening congestive heart failure and New York Heart Association functional class III or IV.
PLFLG AS patients had a significantly higher proportion with a history of atrial fibrillation/flutter as compared with NFHG AS patients. All-cause mortality of PLFLG AS patients was worse than that of NFHG AS patients (P = 0.047). Hospitalization for valve-related symptoms or worsening congestive heart failure was more frequent in PLFLG AS patients than in NFHG AS patients (P = 0.041). New York Heart Association functional class III-IV after TAVR was more frequently observed in PLFLG AS patients (P = 0.019).
The outcomes of PLFLG AS patients were worse than those of NFHG AS patients in this study. Preexisting atrial fibrillation/flutter was frequent in PLFLG AS patients, and may affect their post-TAVR outcomes. Therefore, closer post-TAVR follow-up should be considered for these patients.
在矛盾性低流量低梯度重度主动脉瓣狭窄（PLFLG AS）患者中，尽管左心室射血分数（LVEF）正常，但每搏输出量指数（SVI）降低。尽管已经知道 SVI 降低是预后不良的预测因素，但经导管主动脉瓣置换术（TAVR）后 PLFLG AS 患者的结局尚未明确界定。我们回顾性比较了 PLFLG AS 患者与正常流量高梯度主动脉瓣狭窄（NFHG AS）患者 TAVR 后的结局。
本观察性研究纳入了 245 例 NFGH AS 患者（平均跨主动脉压力梯度≥40mmHg，LVEF≥50%）和 48 例 PLFLG AS 患者（平均跨主动脉压力梯度<40mmHg，LVEF≥50%，SVI<35ml/m2）。终点事件为全因死亡率、因瓣膜相关症状或充血性心力衰竭恶化而住院以及纽约心脏协会心功能分级 III 或 IV 级。
PLFLG AS 患者既往心房颤动/扑动的比例明显高于 NFHG AS 患者。PLFLG AS 患者的全因死亡率差于 NFHG AS 患者（P=0.047）。PLFLG AS 患者因瓣膜相关症状或充血性心力衰竭恶化而住院的频率高于 NFHG AS 患者（P=0.041）。TAVR 后 PLFLG AS 患者的纽约心脏协会心功能分级 III-IV 更为常见（P=0.019）。
在本研究中，PLFLG AS 患者的结局比 NFHG AS 患者差。PLFLG AS 患者常伴有既往心房颤动/扑动，这可能影响其 TAVR 后的结局。因此，应考虑对这些患者进行更密切的 TAVR 后随访。
