Progression of Normal Flow Low Gradient “Severe” Aortic Stenosis With Preserved Left Ventricular Ejection Fraction
Section snippets
Methods
We retrospectively identified all cases of NF-LG-SAS with preserved LVEF diagnosed from 2005 to 2015 at the echocardiography laboratories of three academic centers (Amiens, Lille, and Brussels). Inclusion criteria were (1) the presence of NF-LG “severe” AS with preserved LVEF diagnosed by transthoracic echocardiography based on the following criteria: AVA <1 cm², mean pressure gradient (MPG) <40 mm Hg, indexed stroke volume ≥35 ml/m², and LVEF ≥50% and (2) availability of a second follow-up
Results
The baseline demographic and clinical characteristics of the 96 patients are presented in Table 1. The median age was 79 years, with a predominance of women (62%). More than 75% of the study population had hypertension, one-quarter had diabetes mellitus, and almost 40% had coronary artery disease. The Charlson co-morbidity index and Euroscore II were low at echocardiographic diagnosis, with a median of 3 and 2.01, respectively. Patients were mostly asymptomatic or pauci-symptomatic (83%) at
Discussion
We demonstrate significant hemodynamic progression over time in NF-LG-SAS with preserved LVEF. Indeed, at follow-up, we observed worsening of at least 1 parameter of AS severity quantification (MPG, peak aortic jet velocity, or AVA) in >80% of patients. Mean MPG and peak aortic jet velocity were significantly higher at follow-up than at baseline (p <0.001 both), with 48% of patients developing the hemodynamic profile of HG-SAS. Median annual rates of progression of MPG and peak aortic jet
Author Contribution
The contribution of the authors is as follows:
Design of the study: Tribouilloy.
Acquisition of data: All authors.
Analysis and interpretation of data: Chadha, Bohbot, Tribouilloy.
Drafting of the manuscript: Chadha, Bohbot, Tribouilloy;
Critical revision for important intellectual content: All authors.
Statistical analysis: Chadha, Bohbot.
Study supervision: Tribouilloy, Maréchaux, Vanoverschelde.
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (0)
Funding: None.
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GC and YB contributed equally to this study and are joint first authors.