부산대학교 도서관

Background: Treatment strategy for low‐gradient (LG) aortic stenosis (AS) remains an unresolved issue. The presence of a low aortic gradient and preserved left ventricular ejection fraction (LVEF) might lead toward the underestimation of aortic stenosis severity and a more conservative management. We sought (a) to describe the nature and timing of intervention according to flow/gradient subgroups in patibents with LG‐AS, (2) to determine the factors associated with the decision to intervene, and (c) to describe prognosis. Methods and Results: One hundred and ten patients prospectively included in this study underwent a standardized clinical and imaging evaluation at inclusion and at 1‐year follow‐up. According to aortic flow, gradient and LVEF, patients were divided into 4 groups: LG‐normal flow [n = 27], LG‐low flow‐low LVEF [n = 27], LG‐low flow‐normal LVEF [n = 16], and high gradient (HG) [n = 40]). 73% of patients underwent AVR 86 ± 59 days after the initial assessment. The HG subgroup had significantly higher intervention rates (P <.001). In multivariable analysis, four parameters were associated with the AVR: aortic gradient (HR 1.52 [1.10‐2.11], P =.012), LVEF (HR 0.58 [0.40‐0.85], P =.006), atrial fibrillation (HR 0.43 [0.021‐0.87], P =.019), and NT‐proBNP (HR 0.92[0.86‐0.98), P =.008]. Patients operated earlier had better outcomes than those having a delayed AVR (P =.042). LG‐AS patients had worse outcomes than HG‐AS patients (P <.001). Conclusion: Compared to HG‐AS, LG‐AS is less likely to benefit from an AVR and had a significantly worse outcome. Further interventional studies are needed to investigate the timing of AVR in these patients. [ABSTRACT FROM AUTHOR]