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Prognostic indicators in Low-Flow, Low-Gradient Aortic Stenosis: insights from a multicenter study
Session:
Sessão de Posters 31 - Intervenção transcateter na válvula aórtica: acesso, futilidade e anatomia complexa
Speaker:
Marta Figueiredo
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
António Maria Fervença Rocha Almeida; Marta Figueiredo; Rafael Viana; Adriana Silva; Rita Louro; Cátia Trigo; Joana Vasconcelos; Isabel João; Manuel Trinca
Abstract
<p>Introduction: Low-flow, low-gradient (LFLG) aortic stenosis (AS) is characterized by discordant findings on resting echocardiography, posing diagnostic challenges. Current evidence suggests that patients with LFLG AS have higher all-cause mortality and heart failure (HF) hospitalizations compared to other AS subtypes.</p> <p>Purpose: To identify baseline characteristics that predict clinical outcomes in patients with LFLG AS.</p> <p>Methods: Multicenter, retrospective study. We included consecutive patients admitted with LFLG AS between 2021 and 2023 who underwent echocardiography while in sinus rhythm. Patients with missing echocardiographic data were excluded. Data collected included demographics, resting echocardiographic parameters, N-terminal pro B-type natriuretic peptide (NT-proBNP), and aortic valve calcium score (AVCS). The primary outcome was a composite of all-cause mortality and HF hospitalization; secondary outcomes included all-cause mortality and HF hospitalization individually.</p> <p>Results: A total of 51 patients were included, with 60% being male. Baseline characteristics are summarized in Table 1.</p> <p>Based on echocardiography data, 66% of patients were classified as classical LFLG and 34% as paradoxical LFLG. Regarding outcomes, 64% met the primary outcome, 46% had HF hospitalization and 48% died.</p> <p>Univariate analysis revealed that hypertension (69% vs. 38%, p=0.030), smoking (82% vs. 59%), AF (83% vs. 57%, p=0.026), classical LFLG (76% vs. 41%, p=0.034), and lower LVEF (39% vs. 48%, p=0.027) were associated with the primary outcome. However, no independent predictors were found. Predictors of HF hospitalization included lower DVI (0.21 vs. 0.23; p=0.039), lower LVEF (38% vs. 46%; p=0.041), history of AF (37% vs. 82%; p=0.010), and classical LFLG AS (62% vs. 20%; p=0.007). Multivariate analysis showed that AF (p=0.008), DVI (p=0.024), and LVEF (p=0.035) were independent predictors of HF hospitalization. There were no significant predictors for all-cause mortality.</p> <p>Conclusion: In our cohort of patients with LFLG AS, hypertension, smoking history, AF, classical form of LFLG, and reduced LVEF were associated with the composite outcome of all-cause mortality and HF hospitalization. However, no independent predictors for this combined endpoint were identified. Regarding HF hospitalization, AF, lower DVI and reduced LVEF were independently associated with more hospitalization. Although several baseline characteristics were linked to adverse outcomes, no predictors of all-cause mortality were established. These results highlight the importance of comprehensive baseline evaluation for risk stratification and management in this challenging population. Further studies are necessary to validate our findings.</p>
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