1. Clinical and echocardiographic features of paradoxical low-flow and normal-flow severe aortic stenosis patients with concomitant mitral regurgitation.
- Author
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Ngiam JN, Chew N, Teng R, Kochav JD, Kochav SM, Tan BY, Sim HW, Sia CH, Kong WKF, Tay ELW, Yeo TC, and Poh KK
- Subjects
- Aged, Aged, 80 and over, Aortic Valve physiopathology, Aortic Valve Stenosis complications, Aortic Valve Stenosis physiopathology, Diastole, Female, Humans, Male, Middle Aged, Mitral Valve physiopathology, Mitral Valve Insufficiency complications, Mitral Valve Insufficiency physiopathology, Predictive Value of Tests, Prognosis, Retrospective Studies, Severity of Illness Index, Stroke Volume, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnostic imaging, Echocardiography, Doppler, Color, Echocardiography, Doppler, Pulsed, Hemodynamics, Mitral Valve diagnostic imaging, Mitral Valve Insufficiency diagnostic imaging, Ventricular Function, Left
- Abstract
Mitral regurgitation (MR) coexists in a significant proportion of patients with severe aortic stenosis (AS), and portends inferior therapeutic outcomes. In severe AS, MR is thought to contribute to a low-flow state by decreasing forward stroke volume. We investigated concomitant MR on the clinical and echocardiographic features of patients with "paradoxical" low-flow (PLF) and normal-flow (NF) severe AS. Clinical and echocardiographic profiles of 886 consecutive patients with index echocardiographic diagnosis of severe AS (AVA < 1.0 cm
2 ) were analysed retrospectively. All patients had preserved ejection fraction (LVEF ≥ 50%, n = 645), and were divided into PLF (stroke volume index, SVI < 35 mL/m2 ) and NF AS. They were then further subdivided based on the presence or absence of moderate-or-severe MR (msMR). A higher prevalence of concomitant msMR was observed in patients with PLF AS (14.9%; n = 33/221) compared to those with NF AS (8.0%; n = 34/424). Concomitant msMR was associated with echocardiographic features of increased diastolic dysfunction in both PLF AS and NF AS patients, as evidenced by increased LA diameter (PLF AS 52.9 ± 12.5 to 43.9 ± 8.9 mm; NF AS 29.6 ± 10.8 to 42.4 ± 8.8 mm; p < 0.001) and increased transmitral E/A ratio (PLF AS 1.26 ± 0.56 to 0.92 ± 0.43; NF AS 1.19 ± 0.63 to 0.94 ± 0.45; p = 0.004). Amongst patients with NF AS, msMR was additionally associated with increased E:e' ratio (25.5 ± 15.1 vs 19.3 ± 10.8; p = 0.025). Concomitant MR was more common in PLF AS compared to NF. Although possibly related to the MR, patients severe AS and MR appeared to have more severe diastolic dysfunction. Further studies are warranted to evaluate prognosis and guide management.- Published
- 2020
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