The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Early Hemodynamic Changes and Long-Term Outcome Of Patients With Severe Low Gradient Aortic Stenosis After Transcatheter Aortic Valve Replacement.

DOI: 10.4244/EIJ-D-19-00399

1. Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany, Germany
2. Asklepios proresearch, Hamburg, Germany.
3. Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany.
4. Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany.
5. Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany.
6. Asklepios Klinik St. Georg, Department of Cardiology, Hamburg, Germany.
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Aims:. Approximately 40% of severe aortic stenosis (AS) patients have a low-gradient (<40mmHg) AS (LG-AS). The aim was to investigate the invasively measured hemodynamic 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 hemodynamic assessment by left and right heart catheterization were divided into three groups: normal-flow (NFLG-AS; n=296), paradoxical low-flow (PLFLG-AS; n=153), classical 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), left and right ventricular stroke work index (p<0.001). NFLG-AS was associated with 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 intermediary prognosis. Both groups showed early hemodynamic reverse response after TAVR.

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