Division of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, One Gustave L. Levy Place, New York, NY 10029, USA.
Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, NY, USA.
Eur Heart J Cardiovasc Imaging. 2024 Jan 29;25(2):267-277. doi: 10.1093/ehjci/jead243.
In patients with severe aortic stenosis (AS), low-flow low-gradient (LG) is a known predictor of worse outcomes. However, very LG may represent a distinct population with further cardiac dysfunction. It is unknown whether this population benefits from transcatheter aortic valve replacement (TAVR). We aimed to describe the patient characteristics and clinical outcomes of low-flow very LG severe AS.
This single-centre study included all patients with low-flow severe AS between 2019 and 2021. Patients were divided into groups with very LG [mean pressure gradient (MPG) ≤ 20 mmHg], LG (20 < MPG < 40 mmHg), and high-gradient (HG) (MPG ≥ 40 mmHg). Composite endpoint of all-cause mortality and heart failure rehospitalization was compared. A total of 662 patients [very LG 130 (20%); LG 339 (51%); HG 193 (29%)] were included. Median follow-up was 12 months. Very LG cohort had a higher prevalence of comorbid conditions with lower left ventricular ejection fraction (45% vs. 57% vs. 60%; P < 0.001). There was a graded increase in the risk of composite endpoint in the lower MPG strata (P < 0.001). Among those who underwent TAVR, very LG was an independent predictor of the composite endpoint (adjusted HR 2.42 [1.29-4.55]). While LG and HG cohorts had decreased risk of composite endpoint after TAVR compared with conservative management, very LG was not associated with risk reduction (adjusted HR 0.69 [0.35-1.34]).
Low-flow very LG severe AS represents a distinct population with significant comorbidities and worse outcomes. Further studies are needed to evaluate the short- and long-term benefits of TAVR in this population.
在严重主动脉瓣狭窄（AS）患者中，低流量低梯度（LG）是预后较差的已知预测指标。然而，非常 LG 可能代表存在进一步心功能障碍的一个特定人群。尚不清楚该人群是否受益于经导管主动脉瓣置换术（TAVR）。我们旨在描述低流量非常 LG 严重 AS 的患者特征和临床结局。
这项单中心研究纳入了 2019 年至 2021 年间所有低流量严重 AS 患者。患者分为非常 LG [平均压力梯度（MPG）≤20mmHg]、LG（20<MPG<40mmHg）和高梯度（HG）（MPG≥40mmHg）组。比较全因死亡率和心力衰竭再入院的复合终点。共纳入 662 例患者[非常 LG 130 例（20%）；LG 339 例（51%）；HG 193 例（29%）]。中位随访时间为 12 个月。非常 LG 组合并症患病率较高，左心室射血分数较低（45%比 57%比 60%；P<0.001）。较低 MPG 分层的复合终点风险呈梯度增加（P<0.001）。在接受 TAVR 的患者中，非常 LG 是复合终点的独立预测因素（调整 HR 2.42[1.29-4.55]）。虽然 LG 和 HG 组在接受 TAVR 后与保守治疗相比复合终点风险降低，但非常 LG 与风险降低无关（调整 HR 0.69[0.35-1.34]）。
低流量非常 LG 严重 AS 代表一个具有显著合并症和较差结局的特定人群。需要进一步研究来评估 TAVR 在该人群中的短期和长期获益。
