title: Prognostic impact of global left ventricular hemodynamic afterload in severe aortic stenosis with preserved ejection fraction.
abstract: BACKGROUND
  Global left ventricular (LV) afterload as assessed by valvulo-arterial impedance (Zva), may be an independent predictor of mortality in patients with severe aortic stenosis (AS) and preserved LV ejection fraction (LVEF). However, its quantification using echocardiography may be subject to error measurement. We aimed to determine the prevalence and impact on long-term survival of high Zva, purposely measured by cardiac catheterization.
  
  
  RESULTS
  676 patients with preserved LVEF and severe AS without other valvular heart diseases underwent cardiac catheterization. Zva was derived from catheterization and calculated as follows: mean aortic gradient+systolic blood pressure/indexed LV stroke volume. Zva was considered high when >5mmHg/mL/m(2) based on previous studies. Overall, high Zva was found in 42% of all AS patients. Four-year survival and 8-year survival were significantly reduced in patients with high Zva (74±3% and 57±4%) as compared to those with low Zva (85±2% and 74±3%; p=0.002). After adjustment for all other risk factors, Zva was independently associated with reduced long-term survival (hazard ratio [HR]=1.47 95% CI: 1.04-2.09; p=0.029). Of interest, high Zva remained associated with reduced survival as compared to low Zva, in patients with normal LV stroke volume, but was no longer significant in low flow patients (p=0.98).
  
  
  CONCLUSIONS
  High Zva, estimated invasively in our study, is frequent in patients with severe AS, and appears as a robust and independent predictor of survival. Zva should be used as an additional parameter for risk stratification of severe AS, more particularly in patients with normal flow.
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France. Electronic address: dania.mohty@chu-limoges.fr.
authors.forename: Dania
authors.initials: D
authors.lastname: Mohty
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Boulogne
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Deltreuil
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Cassat
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Najmeddine
authors.initials: N
authors.lastname: Echahidi
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lacroix
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Virot
authors.affiliation: CHU Limoges, Hôpital Dupuytren, Service Cardiologie, Limoges, F-87042, France; INSERM 1094, Faculté de médecine de Limoges, 2, rue Marcland, 87000 Limoges, France; CHU Limoges, Hôpital Dupuytren, Service de Chirurgie Thoracique et Cardiovasculaire, Limoges F-87042, France.
authors.forename: Victor
authors.initials: V
authors.lastname: Aboyans
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology*; D006328:Cardiac Catheterization; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Aortic stenosis; Catheterization; Impedance; Stroke volume; Survival