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Valvuloarterial impedance does not improve risk stratification in low-ejection fraction, low-gradient aortic stenosis: results from a multicentre study
- Source :
- European Journal of Echocardiography. 12:358-363
- Publication Year :
- 2011
- Publisher :
- Oxford University Press (OUP), 2011.
-
Abstract
- Objectives In a multicentre series of patients with low-ejection fraction/low-gradient aortic stenosis (LEF/LGAS), we evaluated the prognostic impact of valvuloarterial impedance (Zva). Background Zva in AS, a measure of global afterload taking into account systemic arterial compliance, has been proposed for risk stratification in paradoxical LGAS. We hypothesized that Zva could help risk stratification in LEF/LGAS. Methods and results We retrospectively calculated Zva (5.6 ± 1.7 mmHg/mL/m2) of 184 consecutive patients (mean age: 71 ± 10 years) with severe symptomatic LEF/LGAS (valve area ≤1 cm², EF ≤40%, mean transaortic pressure gradient ≤40 mmHg) included between 1995 and 2005 in a multicentre registry. Zva was higher in patients with LVEF at rest ≤20% (6.6 ± 2.3 vs. 5.5 ± 1.6; P = 0.05) and correlated negatively with LVEF at rest ( R = −0.25; P = 0.001). Zva was lower in patients without contractile reserve (CR) on dobutamine stress echocardiography (DSE) compared with patients with true severe AS (5.3 ± 1.3 vs. 5.8 ± 1.8 mmHg/mL/m2; P = 0.048). Zva and the variation in stroke volume during DSE were positively correlated ( P = 0.0001) but Zva did not allow distinction between true and pseudo-severe AS (5.8 ± 1.8 vs. 5.3 ± 1.8mmHg/mL/m2; P = 0.30). In the total population, Zva was not predictive of long-term mortality. In the 128 patients who underwent aortic valve replacement, Zva was not predictive of operative death and of long-term mortality. Conclusions Increased Zva is related to low LVEF and more frequent CR on DSE in LEF/LGAS. However, Zva did not allow an accurate distinction between true and pseudo-severe AS and failed to predict operative and long-term mortality after aortic valve replacement, in LEF/LGAS.
- Subjects :
- Male
medicine.medical_specialty
Statistics as Topic
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Ventricular Function, Left
Aortic valve replacement
Afterload
Internal medicine
Confidence Intervals
Odds Ratio
Health Status Indicators
Humans
Medicine
Radiology, Nuclear Medicine and imaging
Aged
Retrospective Studies
Valvuloarterial impedance
Ejection fraction
business.industry
Hemodynamics
Stroke Volume
Aortic Valve Stenosis
General Medicine
Stroke volume
Prognosis
medicine.disease
Stenosis
Aortic valve stenosis
Risk stratification
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Echocardiography, Stress
Subjects
Details
- ISSN :
- 15322114 and 15252167
- Volume :
- 12
- Database :
- OpenAIRE
- Journal :
- European Journal of Echocardiography
- Accession number :
- edsair.doi.dedup.....96ab81062e5f4232a590a66914bcbd2c