Low-gradient aortic stenosis - Operative risk stratification and predictors for long-term outcome: A multicenter study using dobutamine stress hemodynamics

Article

关键词: LEFT-VENTRICULAR DYSFUNCTION;    TRANSVALVULAR PRESSURE-GRADIENTS;    VALVE-REPLACEMENT;    ECHOCARDIOGRAPHY;    MANAGEMENT;    PROGNOSIS;    SURVIVAL;    SEVERITY;    DISEASE;   

DOI  :  10.1161/01.CIR.0000079171.43055.46

来源: SCIE

【 摘 要 】

Background-The prognostic value of dobutamine stress hemodynamic data in the setting of low-gradient aortic stenosis has been addressed in small, single-center studies. Larger studies are needed to define the criteria for selecting the patients who will benefit from valve replacement. Methods and Results-Six centers prospectively enrolled 136 patients with aortic stenosis (96 men; median age, 72 years [range, 65 to 77 years]; median aortic valve area, 0.7 cm(2) [range, 0.6 to 0.8]; mean transaortic gradient, 29 mm Hg [range, 23 to 34 mm Hg]; cardiac index, 2.11 L . min(-1) . m(-2) [range, 1.75 to 2.55 L . min(-1) . m(-2)]). Left ventricular contractile reserve on the dobutamine stress Doppler study was present in 92 patients (group I) and absent in 44 patients (group II). Operative mortality was 5% (3 of 64 patients) in group I compared with 32% (10 of 31 patients) in group II (P=0.0002). Predictors for operative mortality were the lack of contractile reserve (odds ratio, 10.9; 95% confidence interval [CI], 2.6 to 43.4; P=0.001) and a mean transaortic gradient less than or equal to20 mm Hg (odds ratio, 4.7; 95% CI, 1.1 to 21.0; P=0.04). Predictors for long-term survival were valve replacement (hazard ratio, 0.30; 95% CI, 0.17 to 0.53; P=0.001) and left ventricular contractile reserve (hazard ratio, 0.40; 95% CI, 0.23 to 0.69; P=0.001). Conclusions-In the setting of low-gradient aortic stenosis, surgery seems beneficial for most of the patients with left ventricular contractile reserve. In contrast, the postoperative outcome of patients without reserve is compromised by a high operative mortality. Thus, dobutamine stress Doppler hemodynamics may be factored into the risk-benefit analysis for each patient.

【 授权许可】

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