Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.
German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany.
Clin Res Cardiol. 2022 Dec;111(12):1325-1335. doi: 10.1007/s00392-022-02011-4. Epub 2022 Mar 23.
The study objective was to characterize different groups of low-flow low-gradient (LFLG) aortic stenosis (AS) and determine short-term outcomes and long-term mortality according to Valve Academic Research Consortium-3 (VARC-3) endpoint definitions.
Characteristics and outcomes of patients with LFLG AS undergoing transcatheter aortic valve implantation (TAVI) are poorly understood.
All patients undergoing TAVI at our center between 2013 and 2019 were screened. Patients were divided into three groups according to mean pressure gradient (dPmean), ejection fraction (LVEF), and stroke volume index (SVi): high gradient (HG) AS (dPmean ≥ 40 mmHg), classical LFLG (cLFLG) AS (dPmean < 40 mmHg, LVEF < 50%), and paradoxical LFLG (pLFLG) AS (dPmean < 40 mmHg, LVEF ≥ 50%, SVi ≤ 35 ml/m).
We included 1776 patients (956 HG, 447 cLFLG, and 373 pLFLG patients). Most baseline characteristics differed significantly. Median Society of Thoracic Surgeons (STS) score was highest in cLFLG, followed by pLFLG and HG patients (5.0, 3.9 and 3.0, respectively, p < 0.01). Compared to HG patients, odds ratios for the short-term VARC-3 composite endpoints, technical failure (cLFLG, 0.76 [95% confidence interval, 0.40-1.36], pLFLG, 1.37 [0.79-2.31]) and device failure (cLFLG, 1.06 [0.74-1.49], pLFLG, 0.97 [0.66-1.41]) were similar, without relevant differences within LFLG patients. NYHA classes improved equally in all groups. Compared to HG, LFLG patients had a higher 3-year all-cause mortality (STS score-adjusted hazard ratios, cLFLG 2.16 [1.77-2.64], pLFLG 1.53 [1.22-193]), as well as cardiovascular mortality (cLFLG, 2.88 [2.15-3.84], pLFLG, 2.08 [1.50-2.87]).
While 3-year mortality remains high after TAVI in LFLG compared to HG patients, symptoms improve in all subsets after TAVI.
本研究旨在对不同类型的低流量低梯度（LFLG）主动脉瓣狭窄（AS）进行特征描述，并根据 Valve Academic Research Consortium-3（VARC-3）终点定义，确定短期结局和长期死亡率。
经导管主动脉瓣置换术（TAVI）治疗的 LFLG AS 患者的特征和结局尚不清楚。
对 2013 年至 2019 年期间在我们中心接受 TAVI 的所有患者进行筛查。根据平均压力梯度（dPmean）、射血分数（LVEF）和每搏输出量指数（SVi）将患者分为三组：高梯度（HG）AS（dPmean≥40mmHg）、经典 LFLG（cLFLG）AS（dPmean<40mmHg，LVEF<50%）和矛盾性 LFLG（pLFLG）AS（dPmean<40mmHg，LVEF≥50%，SVi≤35ml/m）。
共纳入 1776 例患者（956 例 HG、447 例 cLFLG 和 373 例 pLFLG 患者）。大多数基线特征差异显著。中位胸外科医生协会（STS）评分在 cLFLG 中最高，其次是 pLFLG 和 HG 患者（分别为 5.0、3.9 和 3.0，p<0.01）。与 HG 患者相比，短期 VARC-3 复合终点（技术失败，cLFLG 为 0.76（95%置信区间，0.40-1.36），pLFLG 为 1.37（0.79-2.31））和器械失败（cLFLG 为 1.06（0.74-1.49），pLFLG 为 0.97（0.66-1.41））的比值比相似，而 LFLG 患者之间无明显差异。所有组的纽约心脏协会（NYHA）心功能分级均得到同等改善。与 HG 相比，LFLG 患者的 3 年全因死亡率（STS 评分调整后的风险比，cLFLG 为 2.16（1.77-2.64），pLFLG 为 1.53（1.22-193））和心血管死亡率（cLFLG 为 2.88（2.15-3.84），pLFLG 为 2.08（1.50-2.87））均较高。
与 HG 患者相比，LFLG 患者在 TAVI 后 3 年的死亡率仍然较高，但所有亚组在 TAVI 后症状均得到改善。
