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Left Ventricular Hypertrophic Change Indicating Poor Prognosis in Patients With Normal-Flow, Low-Gradient Severe

Yu Kawada1, Shuichi Kitada1, Kenta Hachiya2

  • 1Department of Cardiology, Nagoya City University Graduate School of Medical Sciences Nagoya Japan.

Circulation Reports
|June 17, 2021
PubMed

Insights

Risk stratification for normal-flow, low-gradient severe aortic stenosis is challenging. Symptoms, LV hypertrophy, and high tricuspid regurgitation velocity predict adverse events, guiding aortic valve replacement decisions.

Area of Science:

  • Cardiology
  • Cardiovascular Medicine
  • Echocardiography

Background:

  • Normal-flow, low-gradient severe aortic stenosis (NFLG-SAS) with preserved ejection fraction presents diagnostic challenges for risk stratification.
  • Accurate prognostication is crucial for timely intervention, such as aortic valve replacement (AVR).

Purpose of the Study:

  • To identify reliable prognostic indicators for adverse events (AEs) in patients with NFLG-SAS and preserved left ventricular ejection fraction (LVEF).
  • To evaluate the association of clinical and echocardiographic factors with cardiovascular outcomes.

Main Methods:

  • A cohort of 66 patients with NFLG-SAS (aortic valve area <1.0 cm², stroke volume index >35 mL/m², mean gradient <40 mmHg, LVEF ≥50%) was analyzed.
  • Cox proportional hazards models were used to investigate factors associated with AEs, defined as cardiovascular death, heart failure hospitalization, or need for AVR.
  • Echocardiographic parameters including LV hypertrophy and tricuspid regurgitation (TR) velocity were assessed.

Main Results:

  • Over a median follow-up of 675 days, 25 AEs occurred, including 4 cardiovascular deaths, 12 heart failure hospitalizations, and 9 AVRs.
  • Fourteen patients progressed to high-gradient SAS.
  • Multivariable analysis identified symptoms (HR 10.276), LV hypertrophy (HR 3.257), and high TR velocity (HR 2.761) as significant predictors of AEs.

Conclusions:

  • Symptom presence, left ventricular hypertrophy, and elevated tricuspid regurgitation velocity are significant prognostic indicators in NFLG-SAS.
  • These factors can aid in risk stratification and inform the timing of aortic valve replacement in this patient population.

Keywords:
Left ventricular hypertrophyNormal-flow, low-gradient severe aortic stenosisPreserved left ventricular ejection fractionPrognosis

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