Factors Associated with Low Flow in Aortic Valve Stenosis - 04/02/16

Doi : 10.1016/j.echo.2015.10.007

Darryl P. Leong, MBBS, MPH, PhD ^a,^b, Stephen Pizzale, MD ^a, Michelle J. Haroun, MD ^a, Payam Yazdan-Ashoori, MD ^a, Karim Ladak, MD ^a, Yang Yang Sun, MD ^a, Faisal Dalak, MD ^a, Said Al-Maashani, MD ^a, Esam A. Elbarasi, MD ^a, Simona Masiero, MD ^c, Sami Ghazal, MD ^a, Hisham Dokainish, MD ^a,^b,^⁎
^a Department of Medicine, McMaster University, Hamilton, Ontario, Canada
^b Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
^c Universita delle Marche, Ancona, Italy

^∗Reprint requests: Hisham Dokainish, MD, McMaster University, Hamilton Health Sciences, 237 Barton Street E, CVSRI #C3 111, Hamilton, ON L8L 2X2, Canada.

Abstract

Background

Low-flow low-gradient aortic stenosis (AS) is a predictor of worse outcome compared with normal-flow AS. Although depressed left ventricular ejection fraction (LVEF) is associated with low flow, there is less evidence to support the role of other indices of cardiac structure and function.

Methods

Clinical and echocardiographic data from patients with native AS and valve areas ≤ 1.0 cm² were retrospectively analyzed to identify characteristics that are associated with low-flow low-gradient AS.

Results

In total, 941 patients were included. On multivariate analysis, factors independently associated with low flow (stroke volume index < 35 mL/m²) included worse right ventricular systolic function, atrial fibrillation, lower LVEF, and higher left ventricular mass, with moderate or severe mitral regurgitation independently associated with low flow in the 694 patients (74%) with preserved LVEFs.

Conclusions

Right ventricular dysfunction and atrial fibrillation are independently associated with low-flow low-gradient AS, while moderate or severe MR is independently associated with low flow in patients with preserved LVEF. These associations with low flow in AS are clinically important to recognize, to avoid underestimation of AS severity.

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Highlights

•	The presence of depressed RV function, AF, higher LV mass, and lower LVEF is independently associated with low flow in aortic valve stenosis.
•	Moderate or severe mitral regurgitation was independently associated with low flow in patients with AS and preserved LVEFs.
•	These associations with low flow are clinically important to recognize, to avoid underestimation of AS severity.

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Keywords : Aortic stenosis, Echocardiography, Hemodynamics, Low-flow low-gradient aortic stenosis, Stroke volume

Abbreviations : AF, AS, AVA, BSA, LFLGAS, LV, LVEF, RV, SVi, TAPSE, Zva

Plan

Methods

Clinical Data

Echocardiographic Analysis

Statistical Analysis

Results

Factors Associated with Low Flow

Factors Independently Associated with Low Flow

Discussion

The Pathophysiology of LFLGAS

Study Limitations

Clinical Implications

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Vol 29 - N° 2

P. 158-165 - février 2016 Retour au numéro

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Factors Associated with Low Flow in Aortic Valve Stenosis - 04/02/16

Abstract

Background

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Plan

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