Outcomes in patients with various forms of aortic stenosis including those with low-flow low-gradient normal and low ejection fraction

Jorge E. Romero, Patricia Chavez, David Goodman-Meza, Anthony A. Holmes, Robert J Ostfeld, Eric D. Manheimer, Robert M. Siegel, Florentino Lupercio, Eric H. Shulman, Matthew Liakos, Mario J. Garcia, Daniel M. Spevack

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Abstract

Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction 55%), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction <55%). Survival analysis was used to compare outcomes of LFLGNEF AS with those of the other cohorts. AS was classified as mild in 591 patients, moderate in 2,358, severe in 500, LFLGNEF in 776, and LFLGLEF in 318. The study group had a mean age of 80.5 years, 61% were women, and the patients were followed for 2.26 ± 1.16 years. Among subjects managed without valve replacement, total mortality for the LFLGNEF AS group was lower compared with that in both the severe AS and the LFLGLEF AS groups (p = 0.007 and p <0.001, respectively). The prognosis for LFLGNEF AS was worse, however, compared with those with mild and moderate AS (p <0.001, both). In conclusion, no survival differences were found among AS types among those who received valve replacement. The survival rate in LFLGNEF is better than that in severe AS or LFLGLEF but is worse than that in mild or moderate AS. Valve replacement seems reasonable to pursue in select patients.

Original languageEnglish (US)
Pages (from-to)1069-1074
Number of pages6
JournalAmerican Journal of Cardiology
Volume114
Issue number7
DOIs
StatePublished - Oct 1 2014

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Aortic Valve Stenosis
Survival Analysis
Survival Rate
Survival
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Outcomes in patients with various forms of aortic stenosis including those with low-flow low-gradient normal and low ejection fraction. / Romero, Jorge E.; Chavez, Patricia; Goodman-Meza, David; Holmes, Anthony A.; Ostfeld, Robert J; Manheimer, Eric D.; Siegel, Robert M.; Lupercio, Florentino; Shulman, Eric H.; Liakos, Matthew; Garcia, Mario J.; Spevack, Daniel M.

In: American Journal of Cardiology, Vol. 114, No. 7, 01.10.2014, p. 1069-1074.

Research output: Contribution to journalArticle

Romero, JE, Chavez, P, Goodman-Meza, D, Holmes, AA, Ostfeld, RJ, Manheimer, ED, Siegel, RM, Lupercio, F, Shulman, EH, Liakos, M, Garcia, MJ & Spevack, DM 2014, 'Outcomes in patients with various forms of aortic stenosis including those with low-flow low-gradient normal and low ejection fraction', American Journal of Cardiology, vol. 114, no. 7, pp. 1069-1074. https://doi.org/10.1016/j.amjcard.2014.07.020
Romero, Jorge E. ; Chavez, Patricia ; Goodman-Meza, David ; Holmes, Anthony A. ; Ostfeld, Robert J ; Manheimer, Eric D. ; Siegel, Robert M. ; Lupercio, Florentino ; Shulman, Eric H. ; Liakos, Matthew ; Garcia, Mario J. ; Spevack, Daniel M. / Outcomes in patients with various forms of aortic stenosis including those with low-flow low-gradient normal and low ejection fraction. In: American Journal of Cardiology. 2014 ; Vol. 114, No. 7. pp. 1069-1074.
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abstract = "Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction 55{\%}), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction <55{\%}). Survival analysis was used to compare outcomes of LFLGNEF AS with those of the other cohorts. AS was classified as mild in 591 patients, moderate in 2,358, severe in 500, LFLGNEF in 776, and LFLGLEF in 318. The study group had a mean age of 80.5 years, 61{\%} were women, and the patients were followed for 2.26 ± 1.16 years. Among subjects managed without valve replacement, total mortality for the LFLGNEF AS group was lower compared with that in both the severe AS and the LFLGLEF AS groups (p = 0.007 and p <0.001, respectively). The prognosis for LFLGNEF AS was worse, however, compared with those with mild and moderate AS (p <0.001, both). In conclusion, no survival differences were found among AS types among those who received valve replacement. The survival rate in LFLGNEF is better than that in severe AS or LFLGLEF but is worse than that in mild or moderate AS. Valve replacement seems reasonable to pursue in select patients.",
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AU - Romero, Jorge E.

AU - Chavez, Patricia

AU - Goodman-Meza, David

AU - Holmes, Anthony A.

AU - Ostfeld, Robert J

AU - Manheimer, Eric D.

AU - Siegel, Robert M.

AU - Lupercio, Florentino

AU - Shulman, Eric H.

AU - Liakos, Matthew

AU - Garcia, Mario J.

AU - Spevack, Daniel M.

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N2 - Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction 55%), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction <55%). Survival analysis was used to compare outcomes of LFLGNEF AS with those of the other cohorts. AS was classified as mild in 591 patients, moderate in 2,358, severe in 500, LFLGNEF in 776, and LFLGLEF in 318. The study group had a mean age of 80.5 years, 61% were women, and the patients were followed for 2.26 ± 1.16 years. Among subjects managed without valve replacement, total mortality for the LFLGNEF AS group was lower compared with that in both the severe AS and the LFLGLEF AS groups (p = 0.007 and p <0.001, respectively). The prognosis for LFLGNEF AS was worse, however, compared with those with mild and moderate AS (p <0.001, both). In conclusion, no survival differences were found among AS types among those who received valve replacement. The survival rate in LFLGNEF is better than that in severe AS or LFLGLEF but is worse than that in mild or moderate AS. Valve replacement seems reasonable to pursue in select patients.

AB - Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction 55%), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction <55%). Survival analysis was used to compare outcomes of LFLGNEF AS with those of the other cohorts. AS was classified as mild in 591 patients, moderate in 2,358, severe in 500, LFLGNEF in 776, and LFLGLEF in 318. The study group had a mean age of 80.5 years, 61% were women, and the patients were followed for 2.26 ± 1.16 years. Among subjects managed without valve replacement, total mortality for the LFLGNEF AS group was lower compared with that in both the severe AS and the LFLGLEF AS groups (p = 0.007 and p <0.001, respectively). The prognosis for LFLGNEF AS was worse, however, compared with those with mild and moderate AS (p <0.001, both). In conclusion, no survival differences were found among AS types among those who received valve replacement. The survival rate in LFLGNEF is better than that in severe AS or LFLGLEF but is worse than that in mild or moderate AS. Valve replacement seems reasonable to pursue in select patients.

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