Author + information
- Received December 3, 2018
- Revision received January 9, 2019
- Accepted January 22, 2019
- Published online April 15, 2019.
- Ulrich Fischer-Rasokat, MD, PhDa,b,∗ (, )
- Matthias Renker, MDa,c,d,
- Christoph Liebetrau, MD, PhDa,b,d,
- Arnaud van Linden, MDc,e,
- Mani Arsalan, MDc,e,
- Maren Weferling, MDa,
- Andreas Rolf, MD, PhDa,b,d,
- Mirko Doss, MD, PhDc,
- Helge Möllmann, MD, PhDf,
- Thomas Walther, MD, PhDc,d,e,
- Christian W. Hamm, MD, PhDa,b,d and
- Won-Keun Kim, MDa,b,c
- aDepartment of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
- bMedical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany
- cDepartment of Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
- dGerman Centre for Cardiovascular Research, Partner Site Rhein-Main, Bad Nauheim, Germany
- eDepartment of Cardiac, Thoracic and Thoracic Vascular Surgery, University Hospital of the Goethe University, Frankfurt am Main, Germany
- fDepartment of Cardiology, Medical Clinic I, St. Johann Hospital, Dortmund, Germany
- ↵∗Address for correspondence:
Dr. Ulrich Fischer-Rasokat, Department of Cardiology, Kerckhoff Heart Center, Benekestraße 2-8, 60231 Bad Nauheim, Germany.
Objectives This study sought to examine whether the prognosis of patients with severe aortic stenosis (AS) having high versus low transvalvular mean pressure gradients (MPGs) is intrinsically different after transcatheter aortic valve replacement (TAVR), even after strict matching of baseline parameters.
Background Patients with low MPG are characterized by higher cardiovascular risk and more comorbidities than other AS patients are.
Methods In this retrospective, single-center study involving 2,282 patients, 3 groups were derived according to the following criteria: 1) high-gradient AS (HG-AS) (MPG ≥40 mm Hg); 2) low-flow, low-gradient AS (LFLG-AS) (MPG <40 mm Hg, ejection fraction [EF] ≤40%, stroke volume index ≤35 ml/m2); 3) paradoxical LFLG-AS (pLFLG-AS) (similar to LFLG-AS but with EF ≥50%). Propensity score matching that included EF was used to compare 1-year survival.
Results A total of 136 patients with HG-AS or LFLG-AS were identified. Kaplan-Meier survival curves were significantly different (p = 0.039), with death occurring in 11 versus 21 patients (hazard ratio: 2.12; 95% confidence interval: 1.02 to 4.39; p = 0.044), respectively. A total of 226 patients with HG-AS or pLFLG-AS were identified and here the curves were identical (p = 0.468), with death occurring in 18 versus 21 patients (hazard ratio: 1.26; 95% confidence interval: 0.67 to 2.38; p = 0.469).
Conclusions This is the first study comparing survival after TAVR of patients with high versus low MPG in matched study populations. Mortality in patients with LFLG-AS was twice that of HG-AS patients. However, it appears that patients with pLFLG-AS might benefit from TAVR to the same extent as patients with HG-AS. There must be still unmasked factors that influence mortality of patients with LFLG-AS.
- low-gradient aortic stenosis
- propensity score matching
- transcatheter aortic valve replacement
- 1-year survival
This work was supported by the Kerckhoff Heart Research Institute together with the Justus Liebig University. Dr. Renker has received speaker fees from St. Jude Medical/Abbott. Dr. Liebetrau has received speaker fees from Abbott. Dr. Doss has received proctor fees from Boston Scientific. Dr. Möllmann has received proctor/speaker fees from Abbott, Biotronik, Edwards Lifesciences, St. Jude Medical, Boston Scientific, and Symetis SA. Dr. Hamm has served on the advisory board for Medtronic. Dr. Kim has received proctor/speaker fees from Abbott, Symetis, St. Jude Medical, and Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 3, 2018.
- Revision received January 9, 2019.
- Accepted January 22, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.