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Minerva Medica 2020 Jul 22

DOI: 10.23736/S0026-4806.20.06817-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

How low is “low-flow” in aortic stenosis? A retrospective analysis of patients with true low-flow/low-gradient aortic stenosis undergoing TAVI

Tanja KUCKEN 1, 2 , Christoph EDLINGER 1, 2, 3, Maki OKAMOTO 1, 2, Marwin BANNEHR 1, 2, Peter JIRAK 3, Michael LICHTENAUER 3, Anja HAASE-FIELITZ 1, 2, Florian KRIZANIC 4, Christian BUTTER 1, 2

1 Department of Cardiology, Heart Center Brandenburg, Bernau/Berlin, Germany; 2 Brandenburg Medical School (MHB) "Theodor Fontane", Neuruppin, Germany; 3 Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University of Salzburg, Salzburg, Austria; 4 Department of Cardiology, Caritas Clinic Pankow, Berlin, Germany


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BACKGROUND: Transcatheter aortic valve implantation (TAVI) is a valuable treatment option for patients with reduced left ventricular ejection fraction (LVEF) and low-flow/low-gradient (LF/LG) aortic stenosis (AS). According to current literature, the presence of severe AS is unlikely in case of severely reduced LVEF and mean pressure gradient (meanPG) below 30 mmHg. However, a considerable number of patients presenting with typical clinical symptoms of severe AS, show gradients below 30 mmHg. We hypothesized, that these patients undergoing TAVI do have a measurable clinical benefit and an improved LVEF.
METHODS: In this single center retrospective cohort study, data from 1,199 patients undergoing TAVI between 2013 and 2017 was analyzed. A 6-month follow-up was performed to assess changes in NT-proBNP, NYHA-class, and LVEF.
RESULTS: 30 patients presented with LVEF <35%, an aortic valve area (AVA <1 cm2), and a meanPG below 30 mmHg. Mean logistic EuroSCORE II was 24.05 ± 10.9. The majority of patients (56 %) showed improved NYHA-class upon follow-up. NT-proBNP-levels decreased from 3,901pg/ml IQR 10,880 to 1,491 pg/ml IQR 2,245 (p < 0.001). LVEF increased from 30 % IQR 6,25 to 40 % IQR 15 (p < 0.001).
CONCLUSIONS: Based on our findings TAVI represents a valuable treatment option even in patients with LF/LG AS and PGmean below 30mmHg.


KEY WORDS: Aortic stenosis; TAVI; Low-flow/low-gradient

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