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Prognostic Value of Right Ventricular Dysfunction and Tricuspid Regurgitation in Patients with Severe Low-Flow Low-Gradient Aortic Stenosis.
Scientific Reports ( IF 3.8 ) Pub Date : 2019-10-10 , DOI: 10.1038/s41598-019-51166-0
Robert Zilberszac 1 , Andreas Gleiss 2 , Ronny Schweitzer 1 , Piergiorgio Bruno 3 , Martin Andreas 4 , Marlies Stelzmüller 4 , Massimo Massetti 3 , Wilfried Wisser 4 , Günther Laufer 4 , Thomas Binder 1 , Harald Gabriel 1 , Raphael Rosenhek 1
Scientific Reports ( IF 3.8 ) Pub Date : 2019-10-10 , DOI: 10.1038/s41598-019-51166-0
Robert Zilberszac 1 , Andreas Gleiss 2 , Ronny Schweitzer 1 , Piergiorgio Bruno 3 , Martin Andreas 4 , Marlies Stelzmüller 4 , Massimo Massetti 3 , Wilfried Wisser 4 , Günther Laufer 4 , Thomas Binder 1 , Harald Gabriel 1 , Raphael Rosenhek 1
Affiliation
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Long and mid-term data in Low-Flow Low-Gradient Aortic Stenosis (LFLG-AS) are scarce. The present study sought to identify predictors of outcome in a sizeable cohort of patients with LFLG-AS. 76 consecutive patients with LFLG-AS (defined by a mean gradient <40 mmHg, an aortic valve area ≤1 cm2 and an ejection fraction ≤50%) were prospectively enrolled and followed at regular intervals. Events defined as aortic valve replacement (AVR) and death were assessed and overall survival was determined. 44 patients underwent AVR (10 transcatheter and 34 surgical) whilst intervention was not performed in 32 patients, including 9 patients that died during a median waiting time of 4 months. Survival was significantly better after AVR with survival rates of 91.8% (CI 71.1-97.9%), 83.0% (CI 60.7-93.3%) and 56.3% (CI 32.1-74.8%) at 1,2 and 5 years as compared to 84.3% (CI 66.2-93.1%), 52.9% (CI 33.7-69.0%) and 30.3% (CI 14.6-47.5%), respectively, for patients managed conservatively (p = 0.017). The presence of right ventricular dysfunction (HR 3.47 [1.70-7.09]) and significant tricuspid regurgitation (TR) (HR 2.23 [1.13-4.39]) independently predicted overall mortality while the presence of significant TR (HR 3.40[1.38-8.35]) and higher aortic jet velocity (HR 0.91[0.82-1.00]) were independent predictors of mortality and survival after AVR. AVR is associated with improved long-term survival in patients with LFLG-AS. Treatment delays are associated with excessive mortality, warranting urgent treatment in eligible patients. Right ventricular involvement characterized by the presence of TR and/or right ventricular dysfunction, identifies patients at high risk of mortality under both conservative management and after AVR.
中文翻译：
右室功能不全和三尖瓣关闭不全对严重低流量低梯度主动脉瓣狭窄患者的预后价值。
低流量低梯度主动脉瓣狭窄（LFLG-AS）的长期和中期数据很少。本研究试图确定大量LFLG-AS患者的预后指标。前瞻性纳入76例连续的LFLG-AS患者（定义为平均梯度<40 mmHg，主动脉瓣面积≤1cm2，射血分数≤50％），并定期进行随访。评估了定义为主动脉瓣置换（AVR）和死亡的事件，并确定了总生存期。44例患者接受了AVR（10例经导管和34例外科手术），而32例患者未进行干预，其中9例患者在平均等待时间4个月内死亡。AVR后的生存率显着提高，在1时的生存率分别为91.8％（CI 71.1-97.9％），83.0％（CI 60.7-93.3％）和56.3％（CI 32.1-74.8％）。2年和5年，保守治疗的患者分别为84.3％（CI 66.2-93.1％），52.9％（CI 33.7-69.0％）和30.3％（CI 14.6-47.5％）（p = 0.017）。右心功能不全（HR 3.47 [1.70-7.09]）和显着三尖瓣关闭不全（TR）（HR 2.23 [1.13-4.39]）的存在独立地预测了总死亡率，而显着TR（HR 3.40 [1.38-8.35]）的存在和较高的主动脉喷射速度（HR 0.91 [0.82-1.00]）是AVR死亡率和存活率的独立预测因子。AVR与LFLG-AS患者的长期生存期延长有关。延误治疗与死亡率过高有关，需要对符合条件的患者进行紧急治疗。右心室受累的特征是存在TR和/或右心室功能障碍，
更新日期：2019-10-10
中文翻译：
右室功能不全和三尖瓣关闭不全对严重低流量低梯度主动脉瓣狭窄患者的预后价值。
低流量低梯度主动脉瓣狭窄（LFLG-AS）的长期和中期数据很少。本研究试图确定大量LFLG-AS患者的预后指标。前瞻性纳入76例连续的LFLG-AS患者（定义为平均梯度<40 mmHg，主动脉瓣面积≤1cm2，射血分数≤50％），并定期进行随访。评估了定义为主动脉瓣置换（AVR）和死亡的事件，并确定了总生存期。44例患者接受了AVR（10例经导管和34例外科手术），而32例患者未进行干预，其中9例患者在平均等待时间4个月内死亡。AVR后的生存率显着提高，在1时的生存率分别为91.8％（CI 71.1-97.9％），83.0％（CI 60.7-93.3％）和56.3％（CI 32.1-74.8％）。2年和5年，保守治疗的患者分别为84.3％（CI 66.2-93.1％），52.9％（CI 33.7-69.0％）和30.3％（CI 14.6-47.5％）（p = 0.017）。右心功能不全（HR 3.47 [1.70-7.09]）和显着三尖瓣关闭不全（TR）（HR 2.23 [1.13-4.39]）的存在独立地预测了总死亡率，而显着TR（HR 3.40 [1.38-8.35]）的存在和较高的主动脉喷射速度（HR 0.91 [0.82-1.00]）是AVR死亡率和存活率的独立预测因子。AVR与LFLG-AS患者的长期生存期延长有关。延误治疗与死亡率过高有关，需要对符合条件的患者进行紧急治疗。右心室受累的特征是存在TR和/或右心室功能障碍，
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