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You are here: Contents > 2014 > Volume 23 Number 4 July 2014 > AORTIC VALVE DISEASE > ‘Paradoxical’ Low-Flow, Low-Gradient Severe Aortic Valve Stenosis: An Entity with Limited Improvement Following Transcatheter Aortic Valve Implantation

‘Paradoxical’ Low-Flow, Low-Gradient Severe Aortic Valve Stenosis: An Entity with Limited Improvement Following Transcatheter Aortic Valve Implantation

Markus Reinthaler1, Anna Schwabe1, Ulf Landmesser3, Robin Chung1, Suneil Aggarwal1, Nicola Delahunty1, Georg Fröhlich1, Pascal Meier1, Neil Roberts2, Antonis Pantazis1, Michael J. Mullen1

Departments of 1Cardiology and 2Cardiac Surgery, University College London Heart Hospital, London, UK, 3Department of Cardiology, University Hospital, Zurich, Switzerland

Background and aim of the study: The aim of this single-center observational study was to determine the outcome of patients with ‘paradoxical’ low-flow, low-gradient aortic valve stenosis (PLF-LG-AS) after transcatheter aortic valve implantation (TAVI).

Methods: Based on pre-procedural echocardiographic data, a total of 150 patients with severe aortic valve stenosis (AS) (indexed aortic valve area (AVA) ≤ 0.6 cm2/m2) who underwent TAVI at the authors’ institution were allocated retrospectively to three groups: Group 1: PLF-LG-AS (ejection fraction (EF) ≥50%, indexed stroke volume (SV) ≤35 ml/m2, mean AV gradient <40 mmHg; n = 30); Group 2: Classical low-flow, low-gradient AS (CLF-LG-AS: EF <50%, SV ≤35 ml/m2, mean AV gradient <40 mmHg; n = 21); and Group 3: High-gradient AS (HG-AS: EF < or ≥ 50%, mean AV gradient ≥40 mmHg; n = 99).

Results: PLF-LG-AS was associated with an increased

relative wall thickness (RWT) and a higher post-procedural systolic blood pressure (sBP) and pulse pressure (PP) (RWT 60.6 ± 15.3%, sBP 144 ± 14 mmHg, PP 79 ± 15 mmHg) compared to patients with HG-AS or CLF-LG-AS: (RWT 52 ± 13% and 40 ± 9%, p <0.001; sBP 138 ± 15 mmHg and 125 ± 25 mmHg, p = 0.006; PP 68 ± 16 mmHg and 60 ± 21 mmHg, p = 0.01). These patients experienced less improvement in a 6-min walk test (improvement for PLF-LG-AS 14 ± 84 m, for CLF-LG-AS 86 ± 83 m, for HG-AS 87 ± 66 m; intergroup p <0.007). PLF-LG-AS and CLF-LG-AS were also associated with significantly increased one-year overall mortality (PLF-LG-AS 31%, CLF-LG-AS 19%, HG-AS 6%; p = 0.001) and cardiovascular mortality (PLF-LG-AS 20%, CLF-LG-AS 19%, HG-AS 3%; p = 0.002).

Conclusion: Patients with PLF-LG-AS may represent a subgroup with a worse clinical outcome after TAVI.

The Journal of Heart Valve Disease 2014;23:441-449


‘Paradoxical’ Low-Flow, Low-Gradient Severe Aortic Valve Stenosis: An Entity with Limited Improvement Following Transcatheter Aortic Valve Implantation

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