164: Short and long-term outcome of low flow, low gradient severe aortic stenosis with preserved left ventricular ejection fraction: Results from a cardiac catheterization study

BackgroundThe exact prevalence, characteristics and impact on both short- and long-term outcome of low flow, low gradient severe aortic stenosis (LFLG) despite preserved left ventricular ejection fraction (LVEF), remain debatable. The aim of our study is to describe the outcome of a large group of patients with LFLG AS using cardiac catheterization data.Methods and ResultsBetween 2000 and 2010, 770 patients with preserved LVEF (>50%) and severe AS (valve area <1cm2) without significant other valvular heart disease having underwent cardiac catheterization, were retrospectively analyzed. Mean age was 74±8 years, 42% were female, 46% had associated coronary artery disease. LFLG (indexed LV stroke volume<35mL/m2 and mean pressure gradient<40mm Hg) were found in 13% of patients (n=99), normal flow/high gradient (NFHG) in 50% (n=388), LFHG in 14% and NFLG in 22%.In comparison with classical patients with NFHG, those with LFLG were significantly older, and more often female. The cardiac cathererization hemodynamic data including the systemic compliance, vascular systemic resistances and the valvulo-arterial impedance were significantly impaired in LFLG patients as compared to those with NF/HG. Thirty-days mortality was higher in patients with LFLG when compared to NFHG (9 vs. 4%, p=0.06) and 10-year survival was significantly reduced in LFLG (32±8%) when compared to NFHG (66±4%; p=0.0005) (figure). Furthermore, after adjustment for confounding factors, multivariate analysis show that LFLG AS was independently associated with reduced long-term survival: HR= 2.02; 95 CI: (1.31–3.15) p=0.002. Patients who underwent AVR had significantly better longterm survival than those who were managed medically (70 pts) (all p< 0.001) in all our 4 groups of severe AS patients irrespective of the gradient or flow.ConclusionOur cardiac catheterization-based study confirms that LFLG severe AS is a frequent entity associated with poor both short- and long-term outcome. Of interest, AVR seems to be a beneficial therapeutic option, even in patients with LFLG pts.FigureSurvival KM curv