| Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Normal Ejection Fraction Is Associated with Severe Left Ventricular Dysfunction as Assessed by Speckle-Tracking Echocardiography: A Multicenter Study. | |
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MedLine Citation:
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PMID: 22109983 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND: -Low-flow low-gradient (LFLG) is sometimes observed in severe aortic stenosis (AS) despite normal ejection fraction (EF), but its frequency and mechanisms are still debated. We aimed to describe the characteristics of patients with LFLG AS and assess the presence of longitudinal LV dysfunction in these patients. METHODS AND RESULTS: -In a multicentre prospective study, 340 consecutive patients with severe AS and normal EF were studied. Longitudinal LV function was assessed by 2D-strain and global afterload by valvulo-arterial impedance (Zva). Patients were classified according to flow and gradient: low flow was defined as a stroke volume index ≤35 ml/m(2), low gradient as a mean gradient ≤40 mmHg. Most patients (n=258, 75.9%) presented with high gradient AS and 82 patients (24.1%) with low gradient AS. Among the latter, 52 (15.3%) presented with normal flow and low gradient (NFLG), 30 (8.8%) with low flow and low gradient (LFLG). As compared with NFLG, patients with LFLG had more severe AS (AVA=0.7 ±0.12 cm(2) vs 0.86 ±0.14 cm(2)), higher Zva (5.5±1.1 vs 4±0.8 mmHg/ml/m(2)) and worse longitudinal LV function (basal longitudinal strain = -11.6 ± 3.4 vs -14.8 ± 3 %)(p <0.001 for all). CONCLUSIONS: -LFLG AS is observed in 9% of patients with severe AS and normal EF and is associated with high global afterload and reduced longitudinal systolic function. Patients with NFLG AS are more frequent and present with less severe AS, normal afterload, and less severe longitudinal dysfunction. Severe LV longitudinal dysfunction is a new explanation to the concept of LFLG AS. |
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Authors:
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Jérôme Adda; Christopher Mielot; Roch Giorgi; Frédéric Cransac; Xavier Zirphile; Erwan Donal; Catherine Sportouch-Dukhan; Patricia Réant; Stéphane Lafitte; Stéphane Cade; Yvan Le Dolley; Franck Thuny; Nathalie Touboul; Cécile Lavoute; Jean-François Avierinos; Patrizio Lancellotti; Gilbert Habib |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-11-22 |
Journal Detail:
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Title: Circulation. Cardiovascular imaging Volume: - ISSN: 1942-0080 ISO Abbreviation: - Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101479935 Medline TA: Circ Cardiovasc Imaging Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1 la Timone Hospital, Marseille, France; |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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