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. 2024 Mar 6;4(2):oeae018.
doi: 10.1093/ehjopen/oeae018. eCollection 2024 Mar.

Prediction of symptom development and aortic valve replacement in patients with low-gradient severe aortic stenosis

Daisuke Miyahara  1 , Masaki Izumo  1 , Yukio Sato  1 , Tatsuro Shoji  1 , Risako Murata  1 , Ryutaro Oda  1 , Taishi Okuno  1 , Shingo Kuwata  1 , Yoshihiro J Akashi  1
Affiliations

Prediction of symptom development and aortic valve replacement in patients with low-gradient severe aortic stenosis

Daisuke Miyahara et al. Eur Heart J Open. .

Abstract

Aims: Current evidence on the prognostic value of exercise stress echocardiography (ESE) in asymptomatic patients with low-gradient severe aortic stenosis (AS) is limited. Therefore, this study aimed to elucidate its prognostic implications for patients with low-gradient severe AS and determine the added value of ESE in risk stratification for this population.

Methods and results: This retrospective observational study included 122 consecutive asymptomatic patients with either moderate [mean pressure gradient (MPG) < 40 mmHg and aortic valve area (AVA) 1.0-1.5 cm2] or low-gradient severe (MPG < 40 mmHg and AVA < 1.0 cm2) AS and preserved left ventricular ejection fraction (≥50%) who underwent ESE. All patients were followed up for AS-related events. Of 143 patients, 21 who met any exclusion criteria, including early interventions, were excluded, and 122 conservatively managed patients [76.5 (71.0-80.3) years; 48.3% male] were included in this study. During a median follow-up period of 989 (578-1571) days, 64 patients experienced AS-related events. Patients with low-gradient severe AS had significantly lower event-free survival rates than those with moderate AS (log-rank test, P < 0.001). Multivariable Cox regression analysis showed that the mitral E/e' ratio during exercise was independently associated with AS-related events (hazard ratio = 1.075, P < 0.001) in patients with low-gradient severe AS.

Conclusion: This study suggests that asymptomatic patients with low-gradient severe AS have worse prognoses than those with moderate AS. Additionally, the mitral E/e' ratio during exercise is a useful parameter for risk stratification in patients with low-gradient severe AS.

Keywords: Aortic stenosis; E/e′; Exercise stress echocardiography; Low gradient.

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Conflict of interest statement

Conflict of interest: M.I. is a consultant of Edwards Lifesciences and Abbott Medical Japan, and S.K. is a consultant of Abbott Medical Japan. All other authors declare no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Flow chart showing study participant distribution.
Figure 2
Figure 2
Event-free survival curve of moderate aortic stenosis vs. low-gradient severe aortic stenosis.
Figure 3
Figure 3
Event-free survival curve according to mitral E/e′ in patients with low-gradient severe AS.
Figure 4
Figure 4
Event-free survival curve of reduced vs. preserved stroke volume index in patients. PLFLG, paradoxical low-flow low gradient; NFLG, normal-flow low gradient.
See this image and copyright information in PMC

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