title: Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction.
abstract: BACKGROUND
  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.
  
  
  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, 67 ± 10 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 (182 ± 64 versus 212 ± 68 g; P < 0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P = 0.37; major cardiovascular events, 50.9% versus 48.5%, P = 0.58; cardiovascular death, 7.8% versus 4.9%, P = 0.19). Low-gradient severe stenosis patients with reduced stroke volume index (≤ 35 mL/m²; n = 223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P = 0.53).
  
  
  CONCLUSIONS
  Patients with low-gradient "severe" aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis.
authors.affiliation: Herz-Zentrum Bad Krozingen, Bad Krozingen, Germany. nikolaus.jander@herzzentrum.de
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Jander
authors.forename: Jan
authors.initials: J
authors.lastname: Minners
authors.forename: Ingar
authors.initials: I
authors.lastname: Holme
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.forename: Kurt
authors.initials: K
authors.lastname: Boman
authors.forename: Philippe
authors.initials: P
authors.lastname: Brudi
authors.forename: John B
authors.initials: JB
authors.lastname: Chambers
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egstrup
authors.forename: Y Antero
authors.initials: YA
authors.lastname: Kesäniemi
authors.forename: William
authors.initials: W
authors.lastname: Malbecq
authors.forename: Christoph A
authors.initials: CA
authors.lastname: Nienaber
authors.forename: Simon
authors.initials: S
authors.lastname: Ray
authors.forename: Anne
authors.initials: A
authors.lastname: Rossebø
authors.forename: Terje R
authors.initials: TR
authors.lastname: Pedersen
authors.forename: Terje
authors.initials: T
authors.lastname: Skjærpe
authors.forename: Ronnie
authors.initials: R
authors.lastname: Willenheimer
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Bärwolf
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001024:Aortic Valve Stenosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D001384:Azetidines / Q000627:therapeutic use*; D018450:Disease Progression; D004562:Electrocardiography; D000069438:Ezetimibe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012720:Severity of Illness Index; D019821:Simvastatin / Q000627:therapeutic use*; D013318:Stroke Volume / Q000502:physiology*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D019821:Simvastatin; D000069438:Ezetimibe