Right Ventricular Function and Prognosis in XXXX with Low-Flow, Low-Gradient Severe @entity472 .

@entity1 @entity64 @entity452 @entity67 @entity997 @entity472 @entity1002
BACKGROUND: @entity1 with low left ventricular ejection fractions and low-flow, low-gradient @entity472 ( @entity472 ) represent a challenging cohort with high morbidity and mortality. The prevalence and clinical impact of @entity67 ( @entity67 ) on risk stratification and prognosis in these @entity1 is unknown. METHODS: A retrospective analysis was performed of 65 @entity1 with low-flow, low-gradient @entity472 who underwent low-dose @entity452 stress echocardiography to determine @entity472 severity and to ascertain flow reserve status (>= 20% @entity64 volume increase). Clinical, demographic, and imaging data were prospectively collected. Per guidelines, @entity67 was defined as tricuspid annular plane systolic excursion  <  16  mm in the apical four-chamber view and measured at baseline. Cox proportional hazards modeling was used to risk-adjust comparisons for the end point of all-cause mortality. RESULTS: The mean age was 74      9  years, the mean left ventricular ejection fraction was 29      10%, the mean indexed aortic valve (AV) area was 0.49      0.1  cm(2)/m(2), and the mean AV gradient 22      7  mm  Hg. @entity67 was present in 37 @entity1 (57% of the study cohort). After a median follow-up period of 13  months (interquartile range, 5-30  months), there were 29 AV replacements and 30 deaths. The presence of @entity67 (hazard ratio, 2.86; 95% CI, 1.21-6.75; P  =  .02) was an independent risk factor associated with all-cause mortality despite many adjustments for potential clinical and echocardiographic confounders such as AV replacement, Society of Thoracic Surgeons Predicted Risk of Mortality score, severity of @entity997 , and @entity1002 . CONCLUSIONS: Baseline @entity67 is prevalent in @entity1 with low-flow, low-gradient @entity472 undergoing @entity452 stress echocardiography. Quantification of right ventricular systolic function in these complex @entity1 provides important prognostic value and risk stratification adjunctive to Society of Thoracic Surgeons Predicted Risk of Mortality score and should be incorporated into the decision-making process.
