Risk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical intervention

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorTESSARI, Fernanda Castiglioni
dc.contributor.authorLOPES, Maria Antonieta Albanez A. de M.
dc.contributor.authorCAMPOS, Carlos M. M.
dc.contributor.authorROSA, Vitor Emer Egypto
dc.contributor.authorSAMPAIO, Roney Orismar
dc.contributor.authorSOARES, Frederico Jose Mendes Mendonca
dc.contributor.authorLOPES, Rener Romulo Souza
dc.contributor.authorNAZZETTA, Daniella Cian
dc.contributor.authorJR, Fabio Sandoli de Brito
dc.contributor.authorRIBEIRO, Henrique Barbosa
dc.contributor.authorVIEIRA, Marcelo L. C.
dc.contributor.authorJR, Wilson Mathias
dc.contributor.authorFERNANDES, Joao Ricardo Cordeiro
dc.contributor.authorLOPES, Mariana Pezzute
dc.contributor.authorROCHITTE, Carlos E. E.
dc.contributor.authorPOMERANTZEFF, Pablo M. A.
dc.contributor.authorABIZAID, Alexandre
dc.contributor.authorTARASOUTCHI, Flavio
dc.date.accessioned2023-08-16T17:46:17Z
dc.date.available2023-08-16T17:46:17Z
dc.date.issued2023
dc.description.abstractIntroductionClassical low-flow, low-gradient aortic stenosis (LFLG-AS) is an advanced stage of aortic stenosis, which has a poor prognosis with medical treatment and a high operative mortality after surgical aortic valve replacement (SAVR). There is currently a paucity of information regarding the current prognosis of classical LFLG-AS patients undergoing SAVR and the lack of a reliable risk assessment tool for this particular subset of AS patients. The present study aims to assess mortality predictors in a population of classical LFLG-AS patients undergoing SAVR.MethodsThis is a prospective study including 41 consecutive classical LFLG-AS patients (aortic valve area & LE;1.0 cm(2), mean transaortic gradient <40 mmHg, left ventricular ejection fraction <50%). All patients underwent dobutamine stress echocardiography (DSE), 3D echocardiography, and T1 mapping cardiac magnetic resonance (CMR). Patients with pseudo-severe aortic stenosis were excluded. Patients were divided into groups according to the median value of the mean transaortic gradient (& LE;25 and >25 mmHg). All-cause, intraprocedural, 30-day, and 1-year mortality rates were evaluated.ResultsAll of the patients had degenerative aortic stenosis, with a median age of 66 (60-73) years; most of the patients were men (83%). The median EuroSCORE II was 2.19% (1.5%-4.78%), and the median STS was 2.19% (1.6%-3.99%). On DSE, 73.2% had flow reserve (FR), i.e., an increase in stroke volume & GE;20% during DSE, with no significant differences between groups. On CMR, late gadolinium enhancement mass was lower in the group with mean transaortic gradient >25 mmHg [2.0 (0.0-8.9) g vs. 8.5 (2.3-15.0) g; p = 0.034), and myocardium extracellular volume (ECV) and indexed ECV were similar between groups. The 30-day and 1-year mortality rates were 14.6% and 43.8%, respectively. The median follow-up was 4.1 (0.3-5.1) years. By multivariate analysis adjusted for FR, only the mean transaortic gradient was an independent predictor of mortality (hazard ratio: 0.923, 95% confidence interval: 0.864-0.986, p = 0.019). A mean transaortic gradient & LE;25 mmHg was associated with higher all-cause mortality rates (log-rank p = 0.038), while there was no difference in mortality regarding FR status (log-rank p = 0.114).ConclusionsIn patients with classical LFLG-AS undergoing SAVR, the mean transaortic gradient was the only independent mortality predictor in patients with LFLG-AS, especially if & LE;25 mmHg. The absence of left ventricular FR had no prognostic impact on long-term outcomes.eng
dc.description.indexPubMed
dc.description.indexWoS
dc.description.indexScopus
dc.description.sponsorshipFundacao de Amparo a Pesquisa do Estado de Sao Paulo [2013/06149-6]
dc.identifier.citationFRONTIERS IN CARDIOVASCULAR MEDICINE, v.10, article ID 1197408, 9p, 2023
dc.identifier.doi10.3389/fcvm.2023.1197408
dc.identifier.issn2297-055X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/54637
dc.language.isoeng
dc.publisherFRONTIERS MEDIA SAeng
dc.relation.ispartofFrontiers in Cardiovascular Medicine
dc.rightsopenAccesseng
dc.rights.holderCopyright FRONTIERS MEDIA SAeng
dc.subjectaortic stenosiseng
dc.subjectrisk predictioneng
dc.subjectvalve surgeryeng
dc.subjectechocardiographyeng
dc.subjectcardiac magnetic resonanceeng
dc.subject.othercontractile reserveeng
dc.subject.othervalve-replacementeng
dc.subject.otherrecommendationseng
dc.subject.othermulticentereng
dc.subject.wosCardiac & Cardiovascular Systemseng
dc.titleRisk prediction in patients with classical low-flow, low-gradient aortic stenosis undergoing surgical interventioneng
dc.typearticleeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
dspace.entity.typePublication
hcfmusp.citation.scopus0
hcfmusp.contributor.author-fmusphcFERNANDA CASTIGLIONI TESSARI
hcfmusp.contributor.author-fmusphcMARIA ANTONIETA ALBANEZ ALBUQUERQUE DE MEDEIROS LOPES
hcfmusp.contributor.author-fmusphcCARLOS AUGUSTO HOMEM DE MAGALHAES CAMPOS
hcfmusp.contributor.author-fmusphcVITOR EMER EGYPTO ROSA
hcfmusp.contributor.author-fmusphcRONEY ORISMAR SAMPAIO
hcfmusp.contributor.author-fmusphcFREDERICO JOSE MENDES MENDONCA SOARES
hcfmusp.contributor.author-fmusphcRENER ROMULO SOUZA LOPES
hcfmusp.contributor.author-fmusphcDANIELLA CIAN NAZZETTA
hcfmusp.contributor.author-fmusphcFABIO SANDOLI DE BRITO JUNIOR
hcfmusp.contributor.author-fmusphcHENRIQUE BARBOSA RIBEIRO
hcfmusp.contributor.author-fmusphcMARCELO LUIZ CAMPOS VIEIRA
hcfmusp.contributor.author-fmusphcWILSON MATHIAS JUNIOR
hcfmusp.contributor.author-fmusphcJOAO RICARDO CORDEIRO FERNANDES
hcfmusp.contributor.author-fmusphcMARIANA PEZZUTE LOPES
hcfmusp.contributor.author-fmusphcCARLOS EDUARDO ROCHITTE
hcfmusp.contributor.author-fmusphcPABLO MARIA ALBERTO POMERANTZEFF
hcfmusp.contributor.author-fmusphcALEXANDRE ANTONIO CUNHA ABIZAID
hcfmusp.contributor.author-fmusphcFLAVIO TARASOUTCHI
hcfmusp.description.articlenumber1197408
hcfmusp.description.volume10
hcfmusp.origemWOS
hcfmusp.origem.pubmed37378406
hcfmusp.origem.scopus2-s2.0-85163602308
hcfmusp.origem.wosWOS:001013008600001
hcfmusp.publisher.cityLAUSANNEeng
hcfmusp.publisher.countrySWITZERLANDeng
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