Valvular & structural heart disease
Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis
Authors' conclusion
LFLG AS shows an intermediate AVA and gradient progression compared to NFLG and HG AS. The majority of patients initially classified as having LFLG AS changed over time to having other severe forms of AS, and most of them received AVR with a HG AS.
Study context
- Population
- Asymptomatic patients with severe AS (AVA < 1.0 cm²) and normal LVEF (≥ 50%)
- Participants
- 903 patients
- Exposure
- Low-flow low-gradient (LFLG) vs NFLG vs HG severe AS
- HGn = 401reference
- NFLGn = 405
- LFLGn = 97
- Outcome
- Progression of AS (mean gradient, AVA) from baseline to last follow-up or pre-AVR echocardiography
Methodological detailslongitudinal, observational, multicentre, consecutive patients
- Longitudinal
- Observational
- Multicentre
- Consecutive patients
Main finding
As reported in the abstract
Regression coefficient
0.124
P = 0.005
LFLG vs HG
Regression coefficient
0.068
P = 0.018
NFLG vs HG
Regression coefficient
0.056
P = 0.195
LFLG vs NFLG · no difference
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| AVA reductionLFLG vs NFLG · slower AVA reduction with LFLG | P < 0.001 |
Evolution of LFLG AS in conservatively managed patients · during follow-up
- Evolved to NFLG AS
- 19.1% (n = 9)
- Evolved to HG AS
- 44.7% (n = 21)
LFLG baseline patients receiving aortic valve replacement (AVR) with HG AS
- Received AVR with HG AS
- 58.0% (n = 29)
Original publication
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