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Pre-intervention outcomes in patients with high vs low gradient severe aortic stenosis: a real-world comparative analysis
Session:
Sessão de Posters 04 - Prognóstico e desfechos clínicos na estenose aórtica
Speaker:
Mónica Amado
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:
Mónica Amado; Adriana Vazão; André Martins; Joana Pereira; Carolina Esteves; Mariana Carvalho; Luís Graça Santos; David Durão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Introduction: </span></strong><span style="font-size:11.0pt">Severe aortic stenosis (SAS) includes heterogeneous phenotypes that influence clinical presentation</span><span style="font-size:11.0pt"> and management. While high-gradient (HG) SAS reflects classical valvular obstruction, some patients (pts) show low-gradient (LG) SAS despite varied left ventricular ejection fraction (LVEF) values. As transcatheter aortic valve implantation (TAVI) waiting times remain long, identifying phenotype-related differences may support risk stratification.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Objectives: </span></strong><span style="font-size:11.0pt">To characterize and compare pre-intervention outcomes between pts with HG and LG with SAS awaiting TAVI.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Methods: </span></strong><span style="font-size:11.0pt">Single-center retrospective study of SAS pts who underwent pre-TAVI cardiac computed tomography (CCT) protocol between 2022 and 2025. Demographic and clinical data, transthoracic echocardiography (TTE), coronary angiography and CCT parameters were collected. SAS was defined by an aortic valve area (AVA) </span><span style="font-size:11.0pt">≤1 cm2 and categorized as HG (group A) or LG (group B) according to a mean gradient of ≥40 mmHg or <40mmHg, independently of stroke volume, respectively. The pre-procedural endpoint was a composite of: major adverse cardiovascular (CV) events (MACE), consisting of CV mortality, non-fatal acute myocardial infarction or stroke, CV hospitalization and all-cause mortality, whichever occurred first. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Results</span></strong><span style="font-size:11.0pt">: Overall, 240 pts (81.7±5.3 years) underwent pre-TAVI CCT: 189 in group A and 51 pts in group B. <span style="color:black">Although demographics were similar, group B showed exertional angina, arterial hypertension, heart failure, use of antithrombotic, β-blockers and diuretics more frequently (all p<0.05). Group B also presented lower </span>LVEF<span style="color:black"> on both CCT (p<0.001) and TTE (p=0.006), thinner septal (p=0.010) and posterior wall (p=0.007) thicknesses on TTE and a higher aortic valve area indexed to body surface area (p=0.046). Over a median follow-up of 8 months, the pre-procedural endpoint did not differ (p=0.783), although MACE was significantly higher in group B (p=0.008) [table 1].</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Conclusions: </span></strong><span style="font-size:11.0pt">In our population of SAS pts awaiting TAVI, although pre-procedural endpoint did not differ, MACE was higher in pts with LG SAS, a group presenting higher prevalence of CV comorbidities, lower LVEF, and greater use of medications for heart failure management. Further studies may help clarify whether these pts may benefit from higher priority on the TAVI waiting list or if other factors are the driving force for their worse prognosis.</span></span></span></p>
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