Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSPTESSARI, Fernanda CastiglioniLOPES, Maria Antonieta Albanez A. de M.CAMPOS, Carlos M. M.ROSA, Vitor Emer EgyptoSAMPAIO, Roney OrismarSOARES, Frederico Jose Mendes MendoncaLOPES, Rener Romulo SouzaNAZZETTA, Daniella CianJR, Fabio Sandoli de BritoRIBEIRO, Henrique BarbosaVIEIRA, Marcelo L. C.JR, Wilson MathiasFERNANDES, Joao Ricardo CordeiroLOPES, Mariana PezzuteROCHITTE, Carlos E. E.POMERANTZEFF, Pablo M. A.ABIZAID, AlexandreTARASOUTCHI, Flavio2023-08-162023-08-162023FRONTIERS IN CARDIOVASCULAR MEDICINE, v.10, article ID 1197408, 9p, 20232297-055Xhttps://observatorio.fm.usp.br/handle/OPI/54637IntroductionClassical 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.engopenAccessaortic stenosisrisk predictionvalve surgeryechocardiographycardiac magnetic resonancecontractile reservevalve-replacementrecommendationsmulticenterarticleCopyright FRONTIERS MEDIA SA10.3389/fcvm.2023.1197408Cardiac & Cardiovascular Systems