Low-Flow, Low-Gradient Severe AS with Preserved Ejection Fraction: Controversial Outcomes Data

Regardless of treatment approach, prognosis was similar to that in mild-moderate aortic stenosis, but did the study limitations affect the findings?

Patients with severe aortic stenosis (AS) with low gradient (LG) and low flow (LF) can be subdivided into those with low ejection fraction (classical) and those with preserved ejection fraction >50% (paradoxical). Regarding paradoxical LF/LG AS, several studies demonstrated higher operative risk than in high-gradient AS but greater survival with surgery compared with medical management. Now, investigators at two French institutions have retrospectively examined outcomes of 809 patients, all with preserved ejection fraction. Patients had:

Mild-moderate AS,
High-gradient AS,
LG, normal-flow AS, or
LF/LG paradoxical AS.

All patients received solely medical management for the first 3 months (median follow-up, 39 months).

After 3 months, 588 patients …

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)