Predictors of Mortality and Outcomes of Therapy in Low-Flow Severe Aortic Stenosis

Authors:
  • PPPhilippe Pibarot
    Philippe Pibarot
  • IHIrene Hueter
    Irene Hueter
  • WSWilliam J. Stewart
    William J. Stewart
  • SKSamir Kapadia
    Samir Kapadia
  • ETE. Murat Tuzcu
    E. Murat Tuzcu
  • VBVasilis Babaliaros
    Vasilis Babaliaros
  • VTVinod Thourani
    Vinod Thourani
  • WSWilson Y. Szeto
    Wilson Y. Szeto
  • JBJoseph E. Bavaria
    Joseph E. Bavaria
  • SKSusheel Kodali
    Susheel Kodali
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Abstract
Background—: The prognosis and treatment of patients with low-flow (LF) severe aortic stenosis are controversial. Methods and Results—: The Placement of Aortic Transcatheter Valves (PARTNER) trial randomized patients with severe aortic stenosis to medical management versus transcatheter aortic valve replacement (TAVR; inoperable cohort) and surgical aortic valve replacement versus TAVR (high-risk cohort). Among 971 patients with evaluable echocardiograms (92%), LF (stroke volume index ≤35 mL/m 2 ) was observed in 530 (55%); LF and low ejection fraction (P =0.006). In the inoperable cohort, patients with LF had higher mortality than those with normal flow, but both groups improved with TAVR (46% versus 76% with LF and 38% versus 53% with normal flow; P P =0.02). LF was an independent predictor of mortality in all patient cohorts (hazard ratio, ≈1.5), whereas ejection fraction and gradient were not. Conclusions—: LF is common in severe aortic stenosis and independently predicts mortality. Survival is improved with TAVR compared with medical management and similar with TAVR and surgical aortic valve replacement. A measure of flow (stroke volume index) should be included in the evaluation and therapeutic decision making of patients with severe aortic stenosis. Clinical Trial Registration—: URL: http://www.clinicaltrial.gov . Unique identifier: NCT0053089.4.

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