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Left ventricular dysfunction in patients with high-gradient and low-flow low-gradient aortic stenosis
Session:
Sessão de Posters 39 - Fenótipos de estenose aórtica, imagem e fisiopatologia
Speaker:
Inês Rodrigues
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Inês Arrobas Rodrigues; Leonor Moura; António Gonçalves; Francisco Sousa; Francisca Nunes; Marta Almeida; André Lobo; Rafael Teixeira; Francisco Sampaio; Ricardo Fontes-Carvalho
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background and aim</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Left ventricular (LV) systolic dysfunction is a well-established marker of adverse prognosis in moderate-to-severe aortic stenosis (AS). The mechanisms underlying LV dysfunction are multifactorial and may differ across hemodynamic AS phenotypes. This study aimed to characterize contributing factors to LV dysfunction in patients with high-gradient (HG) versus low-flow low-gradient (LFLG) AS and to compare survival outcomes between these groups.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with moderate-to-severe AS and reduced LV ejection fraction (LVEF<50%) were retrospectively identified. Patients with HG severe AS (mean gradient [MG] ≥40 mmHg and aortic valve area [AVA] ≤1,0cm2) and patients with LFLG AS (AVA ≤1cm2, MG <40mmHg, and stroke volume index ≤35ml/m2) were analysed. The aetiology of LV dysfunction (valvular, ischemic, desynchrony, cardiomyopathy and other) was determined using additional diagnostic modalities available for each patient (electrocardiography, coronary angiography, computed tomography, and cardiac magnetic resonance imaging). Survival differences between the two groups were assessed using time-to-event analyses.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">282 patients with severe AS and LVEF<50% were included, of whom 111 had LFLG AS and 37 had HG AS. Baseline characteristics were comparable between groups, except for coronary artery disease, more frequent in the LFLG group (48.6% vs 35.1%, p=0.056) and beta-blocker use, less common in HG patients (29.7% vs 70.3%, p<0.001). Median LVEF was also lower in the LFLG group (40,7% vs 49%, p<0,001). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the LFLG group, 73.9% of patients had at least one concomitant contributor of LV dysfunction beyond AS, most commonly ischemic heart disease (47.7%), followed by desynchrony (18%), and cardiomyopathies (2%). Only 17.1% had AS as the sole mechanism of LV dysfunction. In contrast, LV dysfunction was attributed exclusively to AS in 54.1% of HG patients (p<0.001), while 45.9% had at least one additional contributing factor (p=0.002).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Kaplan–Meier analysis showed significantly worse survival in the LFLG group (median survival of 3.8 vs 8.7 years, log-rank p<0.001). In multivariable Cox regression, LFLG status remained independently associated with mortality (HR 2.23; 95%CI 1.30–3.81; p=0.004).</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Among patients with AS and reduced LVEF, LFLG patients more frequently had concomitant non-valvular mechanisms of LV dysfunction and had significantly worse survival than HG patients, even after multivariable adjustment for comorbid conditions.</span></span></p>
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