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Outcomes and Predictors of Different Flow-Gradient Patterns of Aortic Stenosis After Transcatheter Aortic Valve

Besir Besir1, Shivabalan Kathavarayan Ramu1, Maryam Muhammad Ali Majeed-Saidan1

  • 1Departments of Cardiovascular Medicine.

The American Journal of Cardiology
|January 24, 2025
PubMed

Insights

Classical low-flow low-gradient aortic stenosis (C-LFLG AS) is linked to higher mortality after transcatheter aortic valve replacement (TAVR). Male gender and comorbidities predict C-LFLG AS, while comorbidities predict mortality in this group.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Diagnostics

Background:

  • Aortic stenosis (AS) presents with varying hemodynamic patterns, including high-gradient (HG), classical low-flow low-gradient (C-LFLG), and normal-flow low-gradient (NFLG) AS.
  • Understanding the clinical factors and post-transcatheter aortic valve replacement (TAVR) outcomes associated with these AS subtypes is crucial for patient management.

Purpose of the Study:

  • To identify clinical factors associated with C-LFLG AS and NFLG AS compared to HG AS.
  • To compare clinical and echocardiographic outcomes after TAVR across different AS flow-gradient patterns.
  • To determine predictors of mortality in the C-LFLG AS population post-TAVR.

Main Methods:

  • Retrospective, single-center study of 1,415 patients with severe AS.
  • Classification into HG AS (mean gradient >40 mm Hg), C-LFLG AS (mean gradient <40 mm Hg, stroke volume index <35 ml/m², LVEF <50%), and NFLG AS (mean gradient <40 mm Hg, stroke volume index ≥35 ml/m², LVEF ≥50%).
  • Logistic regression for C-LFLG AS predictors; Cox regression for mortality predictors in C-LFLG AS.

Main Results:

  • Male gender, multiple comorbidities, and moderate-to-severe mitral/tricuspid regurgitation were associated with C-LFLG AS.
  • C-LFLG AS patients had higher 2-year mortality post-TAVR compared to HG AS.
  • NFLG AS patients showed similar 1-year and higher 2-year mortality post-TAVR compared to HG AS.
  • End-stage renal disease, atrial fibrillation, and comorbidities predicted 2-year mortality in C-LFLG AS patients.

Conclusions:

  • Patients with C-LFLG AS exhibit higher mortality rates after TAVR compared to those with HG AS.
  • Male gender and multiple comorbidities are significant predictors for developing C-LFLG AS.
  • Multiple comorbidities independently predict mortality in the C-LFLG AS population following TAVR.

Keywords:
aortic stenosisclassical low-flow low-gradient (C-LFLG) AShigh-gradient (HG) ASnormal-flow low-gradient (NFLG) AStranscatheter aortic valve replacement (TAVR)

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