Right Ventricular Function and Prognosis in Patients with Low-Flow, Low-Gradient Severe Aortic Stenosis

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Surgery

Background:

• Low-flow, low-gradient aortic stenosis (AS) with reduced left ventricular ejection fraction presents a high-risk clinical scenario.
• The role of right ventricular dysfunction (RVD) in the prognosis of these patients remains unclear.

Purpose of the Study:

• To investigate the prevalence and prognostic impact of RVD in patients with low-flow, low-gradient AS.
• To assess if RVD serves as an independent predictor of mortality in this cohort.

Main Methods:

• Retrospective analysis of 65 patients with low-flow, low-gradient AS undergoing dobutamine stress echocardiography.
• RVD defined by tricuspid annular plane systolic excursion < 16 mm; flow reserve assessed by stroke volume increase ≥20%.
• Cox proportional hazards modeling used for risk-adjusted mortality analysis.

Main Results:

• 57% of patients exhibited RVD at baseline.
• RVD was identified as an independent risk factor for all-cause mortality (HR 2.86; P=.02).
• This association persisted despite adjustments for clinical factors and Society of Thoracic Surgeons Predicted Risk of Mortality score.

Conclusions:

• Baseline RVD is highly prevalent in patients with low-flow, low-gradient AS.
• Quantifying right ventricular function provides significant prognostic information.
• RVD assessment should be integrated into risk stratification and treatment decisions for these complex patients.