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Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction

Citation

Ozkan, A and Hachamovitch, R and Kapadia, SR and Tuzcu, EM and Marwick, TH, Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction, Circulation, 128, (6) pp. 622-631. ISSN 0009-7322 (2013) [Refereed Article]

Copyright Statement

Copyright 2013 American Heart Association

DOI: doi:10.1161/CIRCULATIONAHA.112.001094

Abstract

BACKGROUND: The optimal management of low-gradient "severe" aortic stenosis (mean gradient <40 mm Hg, indexed aortic valve area ≤0.6 cm(2)/m(2)) with preserved left ventricular ejection fraction remains controversial because gradients may be similar after aortic valve replacement (AVR). We compared outcomes of low-gradient severe aortic stenosis with AVR or medical therapy. METHODS AND RESULTS: Comprehensive echocardiographic measurements including hemodynamic calculations were completed in 260 prospectively identified patients with symptomatic low-gradient severe aortic stenosis. Patients were followed up for mortality over 2824 months. AVR was performed in 123 patients (47%). Compared with AVR patients, medically treated patients had a higher prevalence of diabetes mellitus (25% versus 41%, P=0.009), lower stroke volume index (36.48.4 versus 34.48.7 mL/m(2), P=0.02), higher pulmonary artery pressure (3811 versus 4821 mm Hg, P=0.001), and higher creatinine level (1.10.4 versus 1.220.5 mg/dL, P=0.02). These and other clinically relevant variables were entered into a propensity model that reflected likelihood of referral to AVR. This score and other variables were entered into a Cox model to explore the independent effect of AVR on outcome. During follow-up, 105 patients died (40%): 32 (30%) in the AVR group and 73 (70%) in the medical treatment group. AVR (hazard ratio, 0.54; 95% confidence interval, 0.32-0.94; P<0.001) was independently associated with outcome and remained a strong predictor of survival after adjustment for propensity score. Medical therapy was associated with 2-fold greater all-cause mortality than AVR. The protective effect of AVR was similar in 125 patients with normal flow (stroke volume index >35 mL/m(2); P=0.22). CONCLUSIONS: AVR is associated with better survival than medical therapy in patients with symptomatic low-gradient severe AS and preserved left ventricular ejection fraction.

Item Details

Item Type:Refereed Article
Keywords:aortic stenosis, aortic valve, treatment outcome
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:85937
Year Published:2013
Web of Science® Times Cited:59
Deposited By:Menzies Institute for Medical Research
Deposited On:2013-08-15
Last Modified:2014-04-23
Downloads:0

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