title: Prognostic significance of atrial fibrillation and severity of symptoms of heart failure in patients with low gradient aortic stenosis and preserved left ventricular ejection fraction.
abstract: The aims of this study were to investigate the clinical outcomes of patients with low-gradient aortic stenosis despite preserved left ventricular ejection fraction and to assess reliable prognostic clinical-instrumental features in patients experiencing or not experiencing aortic valve replacement (AVR). Clinical-laboratory and echocardiographic data from 167 patients (median age 78 years, interquartile range 69 to 83) with aortic valve areas <1.0 cm(2), mean gradients ≤30 mm Hg, and preserved left ventricular ejection fraction (≥55%), enrolled from 2005 to 2010, were analyzed. During a mean follow-up period of 44 ± 23 months, 33% of patients died. On multivariate analysis, independent predictors of death were baseline New York Heart Association functional class III or IV (hazard ratio 2.16, p = 0.038) and atrial fibrillation (hazard ratio 2.00, p = 0.025). Conversely, AVR was protective (hazard ratio 0.25, p = 0.01). The magnitude of the protective effect of AVR seemed to be relatively more important in patients with atrial fibrillation than in those in sinus rhythm, independently of the severity of symptoms. Age >70 years showed a trend toward being a prognostic predictor (p = 0.082). In conclusion, in patients with low-gradient aortic stenosis despite a preserved left ventricular ejection fraction, AVR was strongly correlated with a better prognosis. Patients with atrial fibrillation associated with advanced New York Heart Association class had the worst prognosis if treated medically but at the same time a relative better benefit from surgical intervention.
authors.affiliation: Division of Cardiology, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Moretti
authors.affiliation: Division of Cardiology, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy. Electronic address: enrico.fabris@hotmail.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Fabris
authors.affiliation: Division of Cardiology, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Morosin
authors.affiliation: Division of Cardiology, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.affiliation: Division of Cardiology, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Division of Cardiology, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pinamonti
authors.affiliation: Division of Cardiac Surgery, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Division of Cardiac Surgery, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Aniello
authors.initials: A
authors.lastname: Pappalardo
authors.affiliation: Division of Cardiology, Cardiovascular Department, "Ospedali Riuniti" and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D005996:Nitroglycerin / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants; D002121:Calcium Channel Blockers; D002317:Cardiovascular Agents; D004232:Diuretics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D004077:Digoxin; D005996:Nitroglycerin