Frequency, characteristics, and outcome of patients with aortic stenosis, left ventricular dysfunction, and high (versus low) trans-aortic pressure gradient.

BACKGROUND Trans-aortic pressure gradient in patients with aortic stenosis and left ventricular systolic dysfunction is typically low but occasionally high. OBJECTIVES To examine the distribution of trans-aortic PG in patients with severe AS and severe LV dysfunction and compare the clinical and echocardiographic characteristics and outcome of patients with high versus low PG. METHODS Using the echocardiographic laboratory database at our institution, 72 patients with severe AS (aortic valve area < or = 1.0 cm2) and severe LV dysfunction (LV ejection fraction < or = 30%) were identified. The characteristics and outcome of these patients were compared. RESULTS PG was high (mean PG > or = 35 mmHg) in 32 patients (44.4%) and low (< 35 mmHg) in 40 (55.6%). Aortic valve area was slightly smaller in patients with high PG (0.63 + 0.15 vs. 0.75 +/- 0.16 cm2 in patients with low PG, P = 0.003), and LV ejection fraction was slightly higher in patients with high PG (26 +/- 5 vs. 22 +/- 5% in patients with low PG, P = 0.005). During a median follow-up period of 9 months 14 patients (19%) underwent aortic valve replacement and 46 patients (64%) died. Aortic valve replacement was associated with lower mortality (age and gender-adjusted hazard ratio 0.19, 95% confidence interval 0.05-0.82), whereas trans-aortic PG was not (P = 0.41). CONCLUSIONS A large proportion of patients with severe AS have relatively high trans-aortic PG despite severe LV dysfunction, a finding partially related to more severe AS and better LV function. Trans-aortic PG is not related to outcome in these patients.

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