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Outcome of Patients With Low-Gradient "Severe" Aortic Stenosis and Preserved Ejection Fraction

Jander, Nikolaus; Minners, Jan; Holme, Ingar; Gerdts, Eva; Boman, Kurt; Brudi, Philippe; Chambers, John B.; Egstrup, Kenneth; Kesaniemi, Y. Antero and Malbecq, William, et al. (2011) In Circulation 123(8). p.887-895
Abstract
Background-Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm(2) and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient "severe" stenosis (defined as aortic valve area < 1.0 cm(2) and mean gradient <= 40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Methods and Results-Outcome in patients with low-gradient "severe" aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm(2); mean... (More)
Background-Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm(2) and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient "severe" stenosis (defined as aortic valve area < 1.0 cm(2) and mean gradient <= 40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Methods and Results-Outcome in patients with low-gradient "severe" aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm(2); mean gradient 25 to 40 mm Hg). The primary end point of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic patients (mean age, 67 +/- 10 years; ejection fraction, >= 55%), baseline echocardiography revealed low-gradient severe stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with low-gradient severe stenosis than in those with moderate stenosis (182 +/- 64 versus 212 +/- 68 g; P < 0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P=0.37; major cardiovascular events, 50.9% versus 48.5%, P=0.58; cardiovascular death, 7.8% versus 4.9%, P=0.19). Low-gradient severe stenosis patients with reduced stroke volume index (<= 35 mL/m(2); n=223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P=0.53). Conclusions-Patients with low-gradient "severe" aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis. (Circulation. 2011;123:887-895.) (Less)
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publication status
published
subject
keywords
aortic valve stenosis, echocardiography, outcome, stroke volume
in
Circulation
volume
123
issue
8
pages
887 - 895
publisher
Lippincott Williams and Wilkins
external identifiers
  • wos:000287801300015
  • scopus:79952453659
ISSN
1524-4539
DOI
10.1161/CIRCULATIONAHA.110.983510
language
English
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yes
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6b950cb5-f115-4d6a-b0df-d52f79bfdf54 (old id 1876288)
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2011-04-01 12:08:16
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2017-10-29 03:58:19
@article{6b950cb5-f115-4d6a-b0df-d52f79bfdf54,
  abstract     = {Background-Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area &lt;1.0 cm(2) and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient "severe" stenosis (defined as aortic valve area &lt; 1.0 cm(2) and mean gradient &lt;= 40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Methods and Results-Outcome in patients with low-gradient "severe" aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm(2); mean gradient 25 to 40 mm Hg). The primary end point of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic patients (mean age, 67 +/- 10 years; ejection fraction, &gt;= 55%), baseline echocardiography revealed low-gradient severe stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with low-gradient severe stenosis than in those with moderate stenosis (182 +/- 64 versus 212 +/- 68 g; P &lt; 0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P=0.37; major cardiovascular events, 50.9% versus 48.5%, P=0.58; cardiovascular death, 7.8% versus 4.9%, P=0.19). Low-gradient severe stenosis patients with reduced stroke volume index (&lt;= 35 mL/m(2); n=223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P=0.53). Conclusions-Patients with low-gradient "severe" aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis. (Circulation. 2011;123:887-895.)},
  author       = {Jander, Nikolaus and Minners, Jan and Holme, Ingar and Gerdts, Eva and Boman, Kurt and Brudi, Philippe and Chambers, John B. and Egstrup, Kenneth and Kesaniemi, Y. Antero and Malbecq, William and Nienaber, Christoph A. and Ray, Simon and Rossebo, Anne and Pedersen, Terje R. and Skjaerpe, Terje and Willenheimer, Ronnie and Wachtell, Kristian and Neumann, Franz-Josef and Gohlke-Baerwolf, Christa},
  issn         = {1524-4539},
  keyword      = {aortic valve stenosis,echocardiography,outcome,stroke volume},
  language     = {eng},
  number       = {8},
  pages        = {887--895},
  publisher    = {Lippincott Williams and Wilkins},
  series       = {Circulation},
  title        = {Outcome of Patients With Low-Gradient "Severe" Aortic Stenosis and Preserved Ejection Fraction},
  url          = {http://dx.doi.org/10.1161/CIRCULATIONAHA.110.983510},
  volume       = {123},
  year         = {2011},
}