Predictors of survival after aortic valve replacement in patients with low-flow and high-gradient aortic stenosis

被引:23
作者
Ding, Wen-Hong [2 ]
Lam, Yat-Yin [1 ]
Duncan, Alison [3 ]
Li, Wei [3 ]
Lim, Eric [3 ]
Kaya, Mehmet G. [4 ]
Chung, Robin [3 ]
Pepper, John R. [3 ]
Henein, Michael Y. [5 ]
机构
[1] Chinese Univ Hong Kong, Prince Wales Hosp, Div Cardiol,Inst Vasc Med, Dept Med & Therapeut,Li Ka Shing Inst Hlth & Sci, Hong Kong, Hong Kong, Peoples R China
[2] Capital Univ Med Sci, Beijing Anzhen Hosp, Dept Paediat Cardiol, Beijing, Peoples R China
[3] Royal Brompton Hosp, London SW3 6LY, England
[4] Erciyes Univ, Dept Cardiol, Erciyes, Turkey
[5] Norrlands Univ Hosp, Ctr Heart, Uema, Sweden
关键词
Aortic stenosis; Aortic valve replacement; Low-flow; High-gradient; Survival; LEFT-VENTRICULAR DYSFUNCTION; LOW TRANSVALVULAR GRADIENTS; CONGESTIVE-HEART-FAILURE; RISK STRATIFICATION; DOBUTAMINE ECHOCARDIOGRAPHY; DOPPLER-ECHOCARDIOGRAPHY; PROGNOSTIC IMPLICATIONS; DILATED CARDIOMYOPATHY; PULMONARY-HYPERTENSION; RELATIVE SURVIVAL;
D O I
10.1093/eurjhf/hfp096
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
To identify predictors of survival following aortic valve replacement (AVR) in patients with low-flow and high-gradient aortic stenosis (AS). Eighty-six patients (aged 71 +/- 10 years) with severe AS [aortic valve mean pressure gradient > 40 mmHg or valve area < 1.0 cm(2)] and left ventricular (LV) dysfunction [ejection fraction (EF) < 50%] underwent AVR. Cox proportional hazards were used to identify independent clinical and echocardiographic predictors of mortality. Operative (30-day) mortality was 10%. Peri-operative mortality was associated with lower mean LVEF, higher mitral E:A ratio, peak systolic pulmonary artery pressure (PSPAP), and serum creatinine (by 12%, 2.3, 28 mmHg, and 74 mmol/L, respectively, all P < 0.001), NYHA class III-IV (100 vs. 65%), concomitant CABG (89 vs. 55%), urgent surgery (78 vs. 35%), and longer bypass-time (by 28 min, all P < 0.05). Mortality at 4 years was 17%. Univariate predictors [hazard ratio (HR)] of 4-year mortality were: lower EF (HR 0.68 per % increase, P < 0.001), presence of restrictive LV filling (HR: 3.52, P < 0.001), raised PSPAP (HR: 1.07, P < 0.001), and CABG (HR: 4.93, P = 0.037). However, only low EF (< 40%, HR 0.74, P = 0.030), the presence of restrictive filling (HR 1.77, P = 0.033), and raised PSPAP (> 45 mmHg, HR 2.71, P = 0.010) remained as independent predictors after multivariate analysis. The severity of pre-operative systolic and diastolic LV dysfunction is the major predictor of mortality following AVR for low-flow and high-gradient AS.
引用
收藏
页码:897 / 902
页数:6
相关论文
共 30 条
[1]   PULMONARY-HYPERTENSION PREDICTS MORTALITY AND MORBIDITY IN PATIENTS WITH DILATED CARDIOMYOPATHY [J].
ABRAMSON, SV ;
BURKE, JF ;
KELLY, JJ ;
KITCHEN, JG ;
DOUGHERTY, MJ ;
YIH, DF ;
MCGEEHIN, FC ;
SHUCK, JW ;
PHIAMBOLIS, TP .
ANNALS OF INTERNAL MEDICINE, 1992, 116 (11) :888-895
[2]  
Ali A, 2005, J HEART VALVE DIS, V14, P64
[3]   DEMONSTRATION OF RESTRICTIVE VENTRICULAR PHYSIOLOGY BY DOPPLER ECHOCARDIOGRAPHY [J].
APPLETON, CP ;
HATLE, LK ;
POPP, RL .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1988, 11 (04) :757-768
[4]  
Bonow Robert O, 2008, Circulation, V118, pe523, DOI 10.1161/CIRCULATIONAHA.108.190748
[5]   PROGNOSIS AFTER VALVE-REPLACEMENT IN PATIENTS WITH SEVERE AORTIC-STENOSIS AND A LOW TRANSVALVULAR PRESSURE-GRADIENT [J].
BROGAN, WC ;
GRAYBURN, PA ;
LANGE, RA ;
HILLS, LD .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1993, 21 (07) :1657-1660
[6]   HEMODYNAMIC DETERMINANTS OF PROGNOSIS OF AORTIC-VALVE REPLACEMENT IN CRITICAL AORTIC-STENOSIS AND ADVANCED CONGESTIVE HEART-FAILURE [J].
CARABELLO, BA ;
GREEN, LH ;
GROSSMAN, W ;
COHN, LH ;
KOSTER, JK ;
COLLINS, JJ .
CIRCULATION, 1980, 62 (01) :42-48
[7]  
Collinson J, 1999, CIRCULATION, V100, P1
[8]   Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction - Prognostic indicators [J].
Connolly, HM ;
Oh, JK ;
Orszulak, TA ;
Osborn, SL ;
Roger, VL ;
Hodge, DO ;
Bailey, KR ;
Seward, JB ;
Tajik, AJ .
CIRCULATION, 1997, 95 (10) :2395-2400
[9]   Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction - Result of aortic valve replacement in 52 patients [J].
Connolly, HM ;
Oh, JK ;
Schaff, HV ;
Roger, VL ;
Osborn, SL ;
Hodge, DO ;
Tajik, AJ .
CIRCULATION, 2000, 101 (16) :1940-1946
[10]   USEFULNESS OF DOBUTAMINE ECHOCARDIOGRAPHY IN DISTINGUISHING SEVERE FROM NONSEVERE VALVULAR AORTIC-STENOSIS IN PATIENTS WITH DEPRESSED LEFT-VENTRICULAR FUNCTION AND LOW TRANSVALVULAR GRADIENTS [J].
DEFILIPPI, CR ;
WILLETT, DL ;
BRICKNER, E ;
APPLETON, CP ;
YANCY, CW ;
EICHHORN, EJ ;
GRAYBURN, PA .
AMERICAN JOURNAL OF CARDIOLOGY, 1995, 75 (02) :191-194