Background. Recently the concept of paradoxical low flow-low gradient aortic stenosis (PLFLG AS) despite preserved ejection fraction (EF) has been introduced. This relatively "new" entity is still controversial; in particular it is not fully understood if PLFLG AS could be considered an end-stage degree of the disease or an intermediate state between moderate and severe AS. Purpose. To evaluate prevalence, clinical presentation and echocardiographic characteristics of PLFLG AS in a population of consecutive patients (pts) with severe AS (aortic valve area = 1.0 cm2) and preserved EF ( = 50%). Methods. We studied 139 consecutive pts with severe AS and preserved EF. Pts were divided into 3 groups: 64 high gradient AS (HG AS with mean gradient = 40 mmHg), 55 normal flow-low gradient AS (NFLG AS with mean gradient < 40 mmHg and stroke volume index >35 ml/m2), 20 PLFLG AS with mean gradient < 40 mmHg and stroke volume index = 35 ml/m2. All patients underwent a comprehensive transthoracic echocardiogram. Arterial valvular impedence (Zva) was calculated as the ratio of systolic LV pressure to LV stroke volume index. Pts were defined symptomatic in presence of angina or syncope or NYHA class >II. Results. Globally, 52 pts (37%) were symptomatic. Pts with HG AS were significantly more symptomatic (55%) than both PLFLG and NFLG ones (p<.001). On the contrary, there were not significant differences between PLFLG and NFLG AS (25% vs 21% respectively; p=ns). Table 1 shows echocardiographic findings in the three groups. The aortic valve area was smallest in HG AS (p<.001); conversely, PLFLG AS showed the highest value of Zva compared to the other two groups (p<.001). Conclusions. The prevalence of PLFLG AS in a group of consecutive AS with preserved EF was 14.3%. Pts with HG AS pathophysiology, in whom the valve itself represents the main problem, are significantly more symptomatic. NFLG AS is a valvular entity nearest to moderate AS than a true severe one. PLFLG AS pts show the highest Zva, due to both valvular and vascular component, and clinically seems to be an intermediate entity between HG AS and NFLG AS.

Paradoxical low-flow low-gradient aortic stenosis: an intermediate state between moderate and severe aortic stenosis?

C Zito;S Carerj;
2016-01-01

Abstract

Background. Recently the concept of paradoxical low flow-low gradient aortic stenosis (PLFLG AS) despite preserved ejection fraction (EF) has been introduced. This relatively "new" entity is still controversial; in particular it is not fully understood if PLFLG AS could be considered an end-stage degree of the disease or an intermediate state between moderate and severe AS. Purpose. To evaluate prevalence, clinical presentation and echocardiographic characteristics of PLFLG AS in a population of consecutive patients (pts) with severe AS (aortic valve area = 1.0 cm2) and preserved EF ( = 50%). Methods. We studied 139 consecutive pts with severe AS and preserved EF. Pts were divided into 3 groups: 64 high gradient AS (HG AS with mean gradient = 40 mmHg), 55 normal flow-low gradient AS (NFLG AS with mean gradient < 40 mmHg and stroke volume index >35 ml/m2), 20 PLFLG AS with mean gradient < 40 mmHg and stroke volume index = 35 ml/m2. All patients underwent a comprehensive transthoracic echocardiogram. Arterial valvular impedence (Zva) was calculated as the ratio of systolic LV pressure to LV stroke volume index. Pts were defined symptomatic in presence of angina or syncope or NYHA class >II. Results. Globally, 52 pts (37%) were symptomatic. Pts with HG AS were significantly more symptomatic (55%) than both PLFLG and NFLG ones (p<.001). On the contrary, there were not significant differences between PLFLG and NFLG AS (25% vs 21% respectively; p=ns). Table 1 shows echocardiographic findings in the three groups. The aortic valve area was smallest in HG AS (p<.001); conversely, PLFLG AS showed the highest value of Zva compared to the other two groups (p<.001). Conclusions. The prevalence of PLFLG AS in a group of consecutive AS with preserved EF was 14.3%. Pts with HG AS pathophysiology, in whom the valve itself represents the main problem, are significantly more symptomatic. NFLG AS is a valvular entity nearest to moderate AS than a true severe one. PLFLG AS pts show the highest Zva, due to both valvular and vascular component, and clinically seems to be an intermediate entity between HG AS and NFLG AS.
2016
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11570/3178513
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