Outcome of flow-gradient patterns of aortic stenosis after aortic valve replacement : an analysis of the PARTNER 2 trial and registry
Lippincott Williams & Wilkins, 2020
Online
unknown
Zugriff:
Background : Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction ≥50% but stroke volume index <35 mL/m2) and LG; and normal-flow (left ventricular ejection fraction ≥50% and stroke volume index ≥35 mL/m2) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups. Methods : A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke. Results : The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% (P=0.002) and normal-flow-LG: 32.1% (P=0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% (P=0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group. Conclusions : The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke ...
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Outcome of flow-gradient patterns of aortic stenosis after aortic valve replacement : an analysis of the PARTNER 2 trial and registry
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Autor/in / Beteiligte Person: | Dahou, Abdellaziz ; Rodés-Cabau, Josep ; Hahn, Rebecca T. ; Beaudoin, Jonathan ; Jaber, Wael A. ; Annabi, Mohamed Salah ; Asch, Federico M. ; Bernier, Mathieu ; Rodriguez, L. Leonardo ; Pibarot, Philippe ; Weissman, Neil J. ; Clavel, Marie-Annick ; Gertz, Zachary M. ; Ong, Géraldine ; Herrmann, Howard C. ; Salaun, Erwan ; Toubal, Oumhani ; Leipsic, Jonathon ; Blanke, Philipp ; Ridard, Carine ; Webb, John G. (John Graydon) ; Zhang, Yiran ; Alu, Maria C. ; Douglas, Pamela S. ; Makkar, Rajendra ; Miller, D. Craig ; Lindman, Brian R. ; Thourani, Vinod H. ; Leon, Martin B. |
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Veröffentlichung: | Lippincott Williams & Wilkins, 2020 |
Medientyp: | unknown |
ISSN: | 1941-7640 (print) |
DOI: | 10.1161/CIRCINTERVENTIONS.119.008792 |
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