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Factors Associated with Low Flow in Aortic Valve Stenosis
Darryl P Leong1, Stephen Pizzale2, Michelle J Haroun2
1Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
Summary
Low-flow low-gradient aortic stenosis (AS) is linked to worse outcomes. Right ventricular dysfunction and atrial fibrillation predict low flow, with mitral regurgitation also associated in patients with preserved ejection fraction.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- Low-flow low-gradient aortic stenosis (AS) is associated with poorer patient outcomes compared to normal-flow AS.
- While reduced left ventricular ejection fraction (LVEF) is known to cause low flow, other cardiac factors are less understood.
Purpose of the Study:
- To identify cardiac structural and functional characteristics associated with low-flow low-gradient AS.
- To investigate factors contributing to low flow in patients with AS, particularly those with preserved LVEF.
Main Methods:
- Retrospective analysis of clinical and echocardiographic data from 941 patients with native AS and valve area ≤ 1.0 cm².
- Multivariate analysis to determine independent predictors of low flow (stroke volume index < 35 mL/m²).
Main Results:
- Right ventricular systolic dysfunction, atrial fibrillation, lower LVEF, and higher left ventricular mass were independently associated with low flow.
- Moderate or severe mitral regurgitation (MR) was independently associated with low flow in 74% of patients with preserved LVEF.
Conclusions:
- Right ventricular dysfunction and atrial fibrillation are key independent predictors of low-flow low-gradient AS.
- Moderate to severe MR is a significant independent predictor of low flow in AS patients with preserved LVEF.
- Recognizing these associations is crucial for accurate AS severity assessment and appropriate management.
Keywords:
Aortic stenosisEchocardiographyHemodynamicsLow-flow low-gradient aortic stenosisStroke volumeMore Related Videos
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