title: Outcomes in patients with various forms of aortic stenosis including those with low-flow low-gradient normal and low ejection fraction.
abstract: Low-flow low-gradient aortic stenosis with normal ejection fraction (LFLGNEF AS) is a newly characterized poorly understood entity within the AS spectrum. Whether LFLGNEF AS has a worse prognosis than typical AS remains controversial. We retrospectively identified 4,546 individual patients with any type of AS on echocardiogram from 2003 through 2013 and categorized them into 5 cohorts: (1) mild AS, (2) moderate AS, (3) severe AS, (4) LFLGNEF AS (ejection fraction≥55%), and (5) low-flow low-gradient low ejection fraction AS (LFLGLEF AS; ejection fraction<55%). Survival analysis was used to compare outcomes of LFLGNEF AS with those of the other cohorts. AS was classified as mild in 591 patients, moderate in 2,358, severe in 500, LFLGNEF in 776, and LFLGLEF in 318. The study group had a mean age of 80.5 years, 61% were women, and the patients were followed for 2.26±1.16 years. Among subjects managed without valve replacement, total mortality for the LFLGNEF AS group was lower compared with that in both the severe AS and the LFLGLEF AS groups (p=0.007 and p<0.001, respectively). The prognosis for LFLGNEF AS was worse, however, compared with those with mild and moderate AS (p<0.001, both). In conclusion, no survival differences were found among AS types among those who received valve replacement. The survival rate in LFLGNEF is better than that in severe AS or LFLGLEF but is worse than that in mild or moderate AS. Valve replacement seems reasonable to pursue in select patients.
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Jorge
authors.initials: J
authors.lastname: Romero
authors.affiliation: Department of Medicine, St Luke's Roosevelt Hospital Center, Mount Sinai School of Medicine, New York, New York.
authors.forename: Patricia
authors.initials: P
authors.lastname: Chavez
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: David
authors.initials: D
authors.lastname: Goodman-Meza
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Holmes
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ostfeld
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Manheimer
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Siegel
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Florentino
authors.initials: F
authors.lastname: Lupercio
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Shulman
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Matthew
authors.initials: M
authors.lastname: Liakos
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York. Electronic address: mariogar@montefiore.org.
authors.forename: Mario J
authors.initials: MJ
authors.lastname: Garcia
authors.affiliation: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Spevack
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D009518:New York / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013318:Stroke Volume; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology*