1. Impact of Mean Transaortic Pressure Gradient on Long-Term Outcome in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction
- Author
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Cedric Kowalski, Dan Rusinaru, Christophe Tribouilloy, Yohann Bohbot, Anne Ringle, Sylvestre Maréchaux, tribouilloy, christophe, Service de Cardiologie [Amiens], CHU Amiens-Picardie, Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux, Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Groupement Hospitalier de l'Institut Catholique de Lille, Faculté Libre de Médecine de Lille (FLM), Institut Catholique de Lille (ICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL)-Institut Catholique de Lille (ICL), Université catholique de Lille (UCL)-Université catholique de Lille (UCL)-UC Lille, Faculté Libre de Médecine-UC Lille, and Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Picardie Jules Verne (UPJV)
- Subjects
Male ,Time Factors ,asymptomatic and minimally symptomatic patients ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,severe aortic stenosis ,Severity of Illness Index ,Ventricular Function, Left ,0302 clinical medicine ,Risk Factors ,Cardiovascular Disease ,Risk of mortality ,030212 general & internal medicine ,Prospective cohort study ,Original Research ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,education.field_of_study ,[SDV.MHEP] Life Sciences [q-bio]/Human health and pathology ,Ejection fraction ,Calcinosis ,Middle Aged ,Echocardiography, Doppler ,Aortic valve area ,Treatment Outcome ,Echocardiography ,Aortic Valve ,Ventricular pressure ,Cardiology ,Female ,France ,Mortality/Survival ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Population ,mean transaortic pressure gradient ,03 medical and health sciences ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,In patient ,education ,Pressure gradient ,Aged ,Proportional Hazards Models ,Retrospective Studies ,End point ,business.industry ,Hemodynamics ,Stroke Volume ,Aortic Valve Stenosis ,medicine.disease ,mortality ,Term (time) ,Stenosis ,Valvular Heart Disease ,Asymptomatic Diseases ,prognosis ,business ,[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology - Abstract
Background Mean transaortic pressure gradient ( MTPG ) has never been validated as a predictor of mortality in patients with severe aortic stenosis. We sought to determine the value of MTPG to predict mortality in a large prospective cohort of severe aortic stenosis patients with preserved left ventricular ejection fraction and to investigate the cutoff of 60 mm Hg, proposed in American guidelines. Methods and Results A total of 1143 patients with severe aortic stenosis defined by aortic valve area ≤1 cm 2 and MTPG ≥40 mm Hg were included. The population was divided into 3 groups according to MTPG : between 40 and 49 mm Hg, between 50 and 59 mm Hg, and ≥60 mm Hg. The end point was all‐cause mortality. MTPG was ≥60 mm Hg in 392 patients. Patients with MTPG ≥60 mm Hg had a significantly increase risk of mortality compared with patients with MTPG HR ]=1.62 [1.27–2.05] P HR =1.56 [1.04–2.34] P =0.032). After adjustment for established outcome predictors, patients with MTPG ≥60 mm Hg had a significantly higher risk of mortality than patients with MTPG HR =1.71 [1.33–2.20] P HR =1.71 [1.43–2.11] P HR =1.70 [1.10–2.32] P =0.018 and HR =1.68 [1.20–2.36] P =0.003, respectively). Conclusions This study shows the negative prognostic impact of high MTPG (≥60 mm Hg), on long‐term outcome of patients with severe aortic stenosis with preserved left ventricular ejection fraction, irrespective of symptoms.
- Published
- 2017
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