Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Galian-Gay Laura, Teixidó-Turà Gisela, Casas Guillem, Ferrer-Sistach Elena, Mitroi Cristina, Mingo Susana, Monivas Vanessa, Saura Daniel, Vidal Bàrbara, Moral Sergio, Calvo Francisco, Sánchez Violeta, Gonzalez Ariana, Guzman-Martínez Gabriela, Noris Mora Marta, Arnau Vives Miguel Ángel, Peteiro Jesús, Bouzas Alberto, González-Alujas Teresa, Gutiérrez Laura, Fernandez-Galera Rubén, Valente Filipa, Guala Andrea, Ruiz-Muñoz Aroa, Dux-Santoy Lydia, Oliveró Soldevila Ruper, Avilés Augusto Sao, Rodríguez Palomares José F, Ferreira-González Ignacio, Evangelista Artur
Аннотация
METHODS AND RESULTS: Longitudinal, observational, multicenter study including consecutive asymptomatic patients with severe AS (aortic valve area, AVA < 1.0 cm²) and normal left ventricle ejection fraction (LVEF ≥ 50%). Patients were classified according to baseline echocardiography into: HG (high gradient; mean gradient ≥ 40 mmHg), NFLG (normal-flow low-gradient; mean gradient < 40 mmHg, indexed systolic volume (SVi) > 35mL/m2), or LFLG (mean gradient < 40 mmHg, SVi ≤ 35 mL/m²). AS progression was analyzed by comparing patients' baseline measurements and their last follow-up measurements or those taken prior to aortic valve replacement (AVR). Of the 903 included patients, 401 (44.4%) were HG, 405 (44.9%) NFLG, and 97 (10.7%) LFLG. Progression of the mean gradient in a linear mixed regression model was greater in low-gradient groups: LFLG vs. HG (regression coefficient 0.124, P = 0.005) and NFLG vs. HG (regression coefficient 0.068, P = 0.018). No differences were observed between the LFLG and NFLG groups (regression coefficient 0.056, P = 0.195). However, AVA reduction was slower in the LFLG group compared to the NFLG (P < 0.001). During follow-up, in conservatively-managed patients, 19.1% (n = 9) of LFLG patients evolved to having NFLG AS and 44.7% (n = 21) to having HG AS. In patients undergoing AVR, 58.0% (n = 29) of LFLG baseline patients received AVR with a HG AS.
CONCLUSION: LFLG AS shows an intermediate AVA and gradient progression compared to NFLG and HG AS. The majority of patients initially classified as having LFLG AS changed over time to having other severe forms of AS, and most of them received AVR with a HG AS.