Low-Gradient Severe Aortic Stenosis: Insights From the CURRENT AS Registry-2

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Tomohiko Taniguchi1, Takeshi Morimoto2, Yasuaki Takeji3

  • 1Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.

JACC. Cardiovascular Interventions
|December 21, 2024
PubMed

Insights

Low-gradient aortic stenosis (LG AS) with reduced ejection fraction and paradoxical low flow, low gradient (LFLG) AS indicate worse outcomes. Normal flow, low gradient (NFLG) AS shows comparable results to high-gradient AS.

Area of Science:

  • Cardiology
  • Aortic Stenosis Research
  • Clinical Outcomes

Background:

  • Low-gradient (LG) aortic stenosis (AS) remains less understood than high-gradient (HG) AS regarding cardiac damage, frailty, and outcomes.
  • Characterizing distinct hemodynamic types of LG AS is crucial for understanding disease progression and patient stratification.

Purpose of the Study:

  • To compare clinical characteristics and outcomes across different hemodynamic subtypes of LG AS and HG AS.
  • To identify specific LG AS phenotypes associated with adverse clinical events.

Main Methods:

  • Analysis of 3,363 patients from the CURRENT AS Registry-2, categorized into four groups: LG AS with reduced LVEF, paradoxical low flow, low gradient (LFLG) AS, normal flow, low gradient (NFLG) AS, and HG AS.
  • Exclusion of patients lacking indexed stroke volume or LVEF data.

Main Results:

  • LG AS with reduced LVEF and paradoxical LFLG AS exhibited more comorbidities, cardiac damage, and frailty, with less severe valve calcification compared to HG AS.
  • The 3-year cumulative incidence of death or heart failure hospitalization was higher in LG AS with reduced LVEF and paradoxical LFLG AS.
  • Adjusted analysis revealed independent associations of LG AS with reduced LVEF (HR: 1.82) and paradoxical LFLG AS (HR: 1.43) with increased risk of death or heart failure hospitalization, unlike NFLG AS (HR: 1.03).

Conclusions:

  • Clinical outcomes are significantly worse for LG AS with reduced LVEF and paradoxical LFLG AS compared to HG AS.
  • NFLG AS demonstrates comparable clinical outcomes to HG AS.
  • These findings highlight the importance of differentiating LG AS subtypes for risk stratification and treatment decisions.
Abstract

Keywords:
aortic stenosisaortic valve replacementprognosis

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