Dataset Information

Association between Comorbidities and Progression of Transvalvular Pressure Gradients in Patients with Moderate and Severe Aortic Valve Stenosis.

ABSTRACT:

Background

Fast progression of the transaortic mean gradient (P _mean) is relevant for clinical decision making of valve replacement in patients with moderate and severe aortic stenosis (AS) patients. However, there is currently little knowledge regarding the determinants affecting progression of transvalvular gradient in AS patients.

Methods

This monocentric retrospective study included consecutive patients presenting with at least two transthoracic echocardiography examinations covering a time interval of one year or more between April 2006 and February 2016 and diagnosed as moderate or severe aortic stenosis at the final echocardiographic examination. Laboratory parameters, medication, and prevalence of eight known cardiac comorbidities and risk factors (hypertension, diabetes, coronary heart disease, peripheral artery occlusive disease, cerebrovascular disease, renal dysfunction, body mass index ?30?Kg/m², and history of smoking) were analyzed. Patients were divided into slow (P _mean < 5?mmHg/year) or fast (P _mean ? 5?mmHg/year) progression groups.

Results

A total of 402 patients (mean age 78 ± 9.4?years, 58% males) were included in the study. Mean follow-up duration was 3.4 ± 1.9?years. The average number of cardiac comorbidities and risk factors was 3.1 ± 1.6. Average number of cardiac comorbidities and risk factors was higher in patients in slow progression group than in fast progression group (3.3 ± 1.5 vs 2.9 ± 1.7; P=0.036). Patients in slow progression group had more often coronary heart disease (49.2% vs 33.6%; P=0.003) compared to patients in fast progression group. LDL-cholesterol values were lower in the slow progression group (100 ± 32.6?mg/dl vs 110.8 ± 36.6?mg/dl; P=0.005).

Conclusion

These findings suggest that disease progression of aortic valve stenosis is faster in patients with fewer cardiac comorbidities and risk factors, especially if they do not have coronary heart disease. Further prospective studies are warranted to investigate the outcome of patients with slow versus fast progression of transvalvular gradient with regards to comorbidities and risk factors.

SUBMITTER: Salinger T

PROVIDER: S-EPMC6252229 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Association between Comorbidities and Progression of Transvalvular Pressure Gradients in Patients with Moderate and Severe Aortic Valve Stenosis.

Salinger Tim T Hu Kai K Liu Dan D Taleh Scharoch S Herrmann Sebastian S Oder Daniel D Gensler Daniel D Müntze Jonas J Ertl Georg G Lorenz Kristina K Frantz Stefan S Weidemann Frank F Nordbeck Peter P

Cardiology research and practice 20181111

<h4>Background</h4>Fast progression of the transaortic mean gradient (<i>P</i> <sub>mean</sub>) is relevant for clinical decision making of valve replacement in patients with moderate and severe aortic stenosis (AS) patients. However, there is currently little knowledge regarding the determinants affecting progression of transvalvular gradient in AS patients.<h4>Methods</h4>This monocentric retrospective study included consecutive patients presenting with at least two transthoracic echocardiogra ...[more]

PMID: 30534431

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Project description:BackgroundCirculatory efficiency reflects the ratio between total left ventricular work and the work required for maintaining cardiovascular circulation. The effect of severe aortic valve stenosis (AS) and aortic valve replacement (AVR) on left ventricular/circulatory mechanical power and efficiency is not yet fully understood. We aimed to quantify left ventricular (LV) efficiency in patients with severe AS before and after surgical AVR.MethodsCirculatory efficiency was computed from cardiovascular magnetic resonance (CMR) imaging derived volumetric data, echocardiographic and clinical data in patients with severe AS (n?=?41) before and 4 months after AVR and in age and sex-matched healthy subjects (n?=?10).ResultsIn patients with AS circulatory efficiency was significantly decreased compared to healthy subjects (9?±?3% vs 12?±?2%; p?=?0.004). There were significant negative correlations between circulatory efficiency and LV myocardial mass (r?=?-?0.591, p?<?0.001), myocardial fibrosis volume (r?=?-?0.427, p?=?0.015), end systolic volume (r?=?-?0.609, p?<?0.001) and NT-proBNP (r?=?-?0.444, p?=?0.009) and significant positive correlation between circulatory efficiency and LV ejection fraction (r?=?0.704, p?<?0.001). After AVR, circulatory efficiency increased significantly in the total cohort (9?±?3 vs 13?±?5%; p?<?0.001). However, in 10/41 (24%) patients, circulatory efficiency remained below 10% after AVR and, thus, did not restore to normal values. These patients also showed less reduction in myocardial fibrosis volume compared to patients with restored circulatory efficiency after AVR.ConclusionIn our cohort, circulatory efficiency is reduced in patients with severe AS. In 76% of cases, AVR leads to normalization of circulatory efficiency. However, in 24% of patients, circulatory efficiency remained below normal values even after successful AVR. In these patients also less regression of myocardial fibrosis volume was seen. Trial Registration clinicaltrials.gov NCT03172338, June 1, 2017, retrospectively registered.

Dataset Information

Association between Comorbidities and Progression of Transvalvular Pressure Gradients in Patients with Moderate and Severe Aortic Valve Stenosis.

Background

Methods

Results

Conclusion

Publications

Association between Comorbidities and Progression of Transvalvular Pressure Gradients in Patients with Moderate and Severe Aortic Valve Stenosis.

Similar Datasets

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