Predictors of true-severe classical low-flow low-gradient aortic stenosis at resting echocardiography.
BACKGROUND
Classical low-flow, low-gradient (LF/LG) aortic stenosis (AS) is subclassified into a true-severe (TS) and a pseudo-severe (PS) subform using low-dose dobutamine stress echocardiography (DSE). In clinical practice a resting peak jet velocity (Vmax) >3.5 m/s or a mean transvalvular gradient (MPG) >35 mmHg suggests the presence of TS classical LF/LG AS, but there is no data to support this. The aim of this study was therefore to investigate whether a resting Vmax >3.5 m/s or MPG >35 mmHg reliably predicted diagnosis of TS classical LF/LG AS.


METHODS
One hundred (100) consecutive patients with classical LF/LG AS were prospectively recruited. All patients underwent DSE for subcategorization. The impact of Vmax and MPG for the presence of the TS subform were analyzed.


RESULTS
TS classical LF/LG AS was diagnosed in 72 patients. Resting Vmax and resting MPG predicted true-severity with an ROC-AUC of 0.737 (95%CI: 0.635-0.838; p < 0.001) and 0.725 (95%CI: 0.615-0.834; p < 0.001), respectively. The optimal positive predictive values (PPV) for the diagnosis of TS classical LF/LG AS were obtained with a resting Vmax >3.5 m/s or resting MPG >35 mmHg. In a multivariate logistic regression analysis, Vmax >3.5 m/s was independently associated with a 5.33-fold odds-ratio of TS classical LF/LG AS (OR 5.33; 95%CI: 1.34-21.18, p = 0.018).


CONCLUSIONS
TS classical LF/LG AS can be reliably predicted by a resting Vmax >3.5 m/s or a resting MPG >35 mmHg. Further imaging for subclassification is not needed in this situation.
['Kellermair|Joerg|J|', 'Saeed|Sahrai|S|', 'Chambers|John B|JB|', 'Kammler|Juergen|J|', 'Blessberger|Hermann|H|', 'Grund|Michael|M|', 'Kiblboeck|Daniel|D|', 'Lambert|Thomas|T|', 'Steinwender|Clemens|C|']
D001021:Aortic Valve D001024:Aortic Valve Stenosis D004452:Echocardiography D006801:Humans D012720:Severity of Illness Index D013318:Stroke Volume D016277:Ventricular Function, Left
Low-flow Low-gradient Aortic stenosis Echocardiography Prediction