Interventions for valvular disease and heart failure

Early haemodynamic changes and long-term outcome of patients with severe low-gradient aortic stenosis after transcatheter aortic valve replacement

EuroIntervention 2020;15:1181-1189. DOI: 10.4244/EIJ-D-19-00399

Jury Schewel
Jury Schewel1, MD; Michael Schlüter2, PhD; Tobias Schmidt1, MD; Karl-Heinz Kuck1, MD; Christian Frerker1, MD; Dimitry Schewel1, MD
1. Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; 2. Asklepios proresearch, Hamburg, Germany

Aims: Approximately 40% of severe aortic stenosis (AS) patients have a low-gradient (<40 mmHg) AS (LG-AS). The aim of this study was to investigate the invasively measured haemodynamic changes and long-term outcome after transcatheter aortic valve replacement (TAVR) in the subgroups of LG-AS.

Methods and results: A total of 600 LG-AS patients with haemodynamic assessment by left and right heart catheterisation were divided into three groups: normal-flow (NFLG-AS; n=296), paradoxical low-flow (PLFLG-AS; n=153), and classic low-flow (CLFLG-AS; n=151). Post TAVR, PLFLG-AS and CLFLG-AS showed a significant reduction in global afterload (p<0.005), as well as a significant elevation of stroke volume index (SVI), and left and right ventricular stroke work index (p<0.001). NFLG-AS was associated with an elevation of global afterload and a decrease of SVI (p<0.05). Overall survival was highest in NFLG-AS, followed by PLFLG-AS and CLFLG-AS. All subgroups experienced similar symptomatic improvement.

Conclusions: NFLG-AS was the most prevalent form of LG severe AS and was associated with adequate left ventricular compensation and good prognosis. On the other hand, CLFLG-AS represents the heart failure with reduced ejection fraction (HFrEF) form of AS and was associated with the worst prognosis, whereas PLFLG-AS represents the heart failure with preserved ejection fraction (HFpEF) form of AS with intermediate prognosis. Both groups showed early haemodynamic reverse response after TAVR.

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aortic stenosisdepressed left ventricular functiontavi
Interventions for valvular diseaseTAVI
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