Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction

Nikolaus Jander; Jan Minners; Ingar Holme; Eva Gerdts; Kurt Boman; Philippe Brudi; John B Chambers; Kenneth Egstrup; Y Antero Kesäniemi; William Malbecq; Christoph A Nienaber; Simon Ray; Anne Rossebø; Terje Pedersen; Terje Skjærpe; Ronnie Willenheimer; Kristian Wachtell; Franz-Josef Neumann; Christa Gohlke-Bärwolf

doi:10.1161/CIRCULATIONAHA.110.983510

Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction

Nikolaus Jander, Jan Minners, Ingar Holme, Eva Gerdts, Kurt Boman, Philippe Brudi, John B Chambers, Kenneth Egstrup, Y Antero Kesäniemi, William Malbecq, Christoph A Nienaber, Simon Ray, Anne Rossebø, Terje Pedersen, Terje Skjærpe, Ronnie Willenheimer, Kristian Wachtell, Franz-Josef Neumann, Christa Gohlke-Bärwolf

Ph.d.-studienævnet for Medicin

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

289 Citationer (Scopus)

Abstract

Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm² and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient "severe" stenosis (defined as aortic valve area <1.0 cm² and mean gradient = 40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study.
Methods and Results—Outcome in patients with low-gradient “severe” aortic stenosis was compared with outcome in
patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm2; mean gradient 25 to 40 mm Hg). The primary end point
of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic
stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic
patients (mean age, 6710 years; ejection fraction, 55%), baseline echocardiography revealed low-gradient severe
stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with
low-gradient severe stenosis than in those with moderate stenosis (18264 versus 21268 g; P0.01). During 46
months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P0.37; major cardiovascular
events, 50.9% versus 48.5%, P0.58; cardiovascular death, 7.8% versus 4.9%, P0.19). Low-gradient severe stenosis
patients with reduced stroke volume index (35 mL/m2; n223) had aortic valve events comparable to those in patients
with normal stroke volume index (46.2% versus 50.9%; P0.53).
Conclusions—Patients with low-gradient “severe” aortic stenosis and normal ejection fraction have an outcome similar to
that in patients with moderate stenosis.

Originalsprog	Engelsk
Tidsskrift	Circulation
Vol/bind	123
Udgave nummer	8
Sider (fra-til)	887-895
Antal sider	9
ISSN	0009-7322
DOI	https://doi.org/10.1161/CIRCULATIONAHA.110.983510
Status	Udgivet - 1 mar. 2011

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Citationsformater

Jander, N., Minners, J., Holme, I., Gerdts, E., Boman, K., Brudi, P., Chambers, J. B., Egstrup, K., Kesäniemi, Y. A., Malbecq, W., Nienaber, C. A., Ray, S., Rossebø, A., Pedersen, T., Skjærpe, T., Willenheimer, R., Wachtell, K., Neumann, F.-J., & Gohlke-Bärwolf, C. (2011). Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction. Circulation, 123(8), 887-895. https://doi.org/10.1161/CIRCULATIONAHA.110.983510

Jander, N, Minners, J, Holme, I, Gerdts, E, Boman, K, Brudi, P, Chambers, JB, Egstrup, K, Kesäniemi, YA, Malbecq, W, Nienaber, CA, Ray, S, Rossebø, A, Pedersen, T, Skjærpe, T, Willenheimer, R, Wachtell, K, Neumann, F-J & Gohlke-Bärwolf, C 2011, 'Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction', Circulation, bind 123, nr. 8, s. 887-895. https://doi.org/10.1161/CIRCULATIONAHA.110.983510

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title = "Outcome of patients with low-gradient {"}severe{"} aortic stenosis and preserved ejection fraction",

abstract = "Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm² and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient {"}severe{"} stenosis (defined as aortic valve area <1.0 cm² and mean gradient = 40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Methods and Results—Outcome in patients with low-gradient “severe” aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm2; mean gradient 25 to 40 mm Hg). The primary end point of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic patients (mean age, 6710 years; ejection fraction, 55%), baseline echocardiography revealed low-gradient severe stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with low-gradient severe stenosis than in those with moderate stenosis (18264 versus 21268 g; P0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P0.37; major cardiovascular events, 50.9% versus 48.5%, P0.58; cardiovascular death, 7.8% versus 4.9%, P0.19). Low-gradient severe stenosis patients with reduced stroke volume index (35 mL/m2; n223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P0.53). Conclusions—Patients with low-gradient “severe” aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis.",

author = "Nikolaus Jander and Jan Minners and Ingar Holme and Eva Gerdts and Kurt Boman and Philippe Brudi and Chambers, {John B} and Kenneth Egstrup and Kes{\"a}niemi, {Y Antero} and William Malbecq and Nienaber, {Christoph A} and Simon Ray and Anne Rosseb{\o} and Terje Pedersen and Terje Skj{\ae}rpe and Ronnie Willenheimer and Kristian Wachtell and Franz-Josef Neumann and Christa Gohlke-B{\"a}rwolf",

year = "2011",

month = mar,

day = "1",

doi = "10.1161/CIRCULATIONAHA.110.983510",

language = "English",

volume = "123",

pages = "887--895",

journal = "Circulation",

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TY - JOUR

T1 - Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction

AU - Jander, Nikolaus

AU - Minners, Jan

AU - Holme, Ingar

AU - Gerdts, Eva

AU - Boman, Kurt

AU - Brudi, Philippe

AU - Chambers, John B

AU - Egstrup, Kenneth

AU - Kesäniemi, Y Antero

AU - Malbecq, William

AU - Nienaber, Christoph A

AU - Ray, Simon

AU - Rossebø, Anne

AU - Pedersen, Terje

AU - Skjærpe, Terje

AU - Willenheimer, Ronnie

AU - Wachtell, Kristian

AU - Neumann, Franz-Josef

AU - Gohlke-Bärwolf, Christa

PY - 2011/3/1

Y1 - 2011/3/1

N2 - Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm² and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient "severe" stenosis (defined as aortic valve area <1.0 cm² and mean gradient = 40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Methods and Results—Outcome in patients with low-gradient “severe” aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm2; mean gradient 25 to 40 mm Hg). The primary end point of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic patients (mean age, 6710 years; ejection fraction, 55%), baseline echocardiography revealed low-gradient severe stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with low-gradient severe stenosis than in those with moderate stenosis (18264 versus 21268 g; P0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P0.37; major cardiovascular events, 50.9% versus 48.5%, P0.58; cardiovascular death, 7.8% versus 4.9%, P0.19). Low-gradient severe stenosis patients with reduced stroke volume index (35 mL/m2; n223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P0.53). Conclusions—Patients with low-gradient “severe” aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis.

AB - Retrospective studies have suggested that patients with a low transvalvular gradient in the presence of an aortic valve area <1.0 cm² and normal ejection fraction may represent a subgroup with an advanced stage of aortic valve disease, reduced stroke volume, and poor prognosis requiring early surgery. We therefore evaluated the outcome of patients with low-gradient "severe" stenosis (defined as aortic valve area <1.0 cm² and mean gradient = 40 mm Hg) in the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Methods and Results—Outcome in patients with low-gradient “severe” aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm2; mean gradient 25 to 40 mm Hg). The primary end point of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic patients (mean age, 6710 years; ejection fraction, 55%), baseline echocardiography revealed low-gradient severe stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with low-gradient severe stenosis than in those with moderate stenosis (18264 versus 21268 g; P0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P0.37; major cardiovascular events, 50.9% versus 48.5%, P0.58; cardiovascular death, 7.8% versus 4.9%, P0.19). Low-gradient severe stenosis patients with reduced stroke volume index (35 mL/m2; n223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P0.53). Conclusions—Patients with low-gradient “severe” aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis.

U2 - 10.1161/CIRCULATIONAHA.110.983510

DO - 10.1161/CIRCULATIONAHA.110.983510

M3 - Journal article

C2 - 21321152

SN - 0009-7322

VL - 123

SP - 887

EP - 895

JO - Circulation

JF - Circulation

IS - 8

ER -