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Predictors of Mortality in Paradoxical Low-Flow, Low-Gradient Aortic Stenosis
Session:
Sessão de Posters 39 - Fenótipos de estenose aórtica, imagem e fisiopatologia
Speaker:
Leonor Moura
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:
Maria Leonor Moura; Francisco Lemos de Sousa; Rafael Teixeira; Francisca Martins Nunes; Inês Arrobas Rodrigues; António Gonçalves; Marta Catarina Almeida; André Lobo; Marta Leite; Inês Neves; Rita Faria; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong>Paradoxical low flow, low gradient aortic stenosis (PLFLGAS) is a relatively common subtype of severe aortic stenosis characterized by preserved ejection fraction in spite of low stroke volume and low transvalvular gradients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose: </strong>The aim of this study was to evaluate three-year mortality in PLFLGAS and its associated and predictive factors.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods: </strong>A retrospective study was conducted, including patients with PLFLGAS from 2012 to 2020. PLFLGAS was defined as aortic valve area ≤1.0 cm², mean gradient <40 mmHg, stroke volume index (SVI) <35 mL/m², and left ventricular ejection fraction (LVEF) ≥ 50%. Mortality related data, demographic characteristics, echocardiographic parameters and clinical comorbidities were collected. Statistical analyses were performed using IBM SPSS Statistics version 30. Mann-Whitney and chi-square tests were used to test the correlations. Univariate logistic regression was used to identify predictors of mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results: </strong>A total of 90 patients were included in this study. At three-year follow up, 24% (n=22) died. Most of these were females (64%) and the median age was 83 years (IQR 8). The mean LVEF was 56%. Mortality was significantly associated with lower LVEF (p=0.002) and age (p=0.010). Aortic valve ejection time (AVET) was higher and LVOT peak gradient was lower in those who died (p=0.010 and p=0.048). Markers of right ventricular dysfunction appeared to be relevant: although TAPSE was not significantly different across groups, PASP was higher in patients who died when compared to those who did not (p=0.019). These also had larger right atrial area (p=0.003) and reduced right ventricular-arterial coupling (p=0.033). Concomitant valvular disease, particularly aortic regurgitation (p=0.036) and mitral regurgitation (p=0.023) were also associated with mortality in PLFLGAS patients. Mortality was predicted in univariate analysis by age (OR 1.13; 95% CI 1.04-1.23; p=0.004), LVEF (OR 0.86; 95% CI 0.76-0.97; p=0.011) and right atrial area (OR 1.15; 95% CI 1.05-1.26; p=0.003). Mitral regurgitation severity was also significant as a predictor of 3-year mortality (Omnibus Wald=7.053, p=0.029).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion: </strong>Three year mortality in PLFLGAS was influenced by age, LVEF, clinical comorbidities and right ventricular dysfunction. Recognition of these factors may help guiding management decisions and underscore the importance of a comprehensive evaluation in these patients.</span></span></p>
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