Lower Transaortic Flow Rate Is Associated With Increased Mortality in Aortic Valve Stenosis.

Abstract

OBJECTIVES:

The association of transaortic flow rate (FR) with outcomes was tested in 1,661 patients with aortic valve stenosis (AS) in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study.

BACKGROUND:

Low transaortic flow may complicate grading of AS. However, the association of lower transaortic FR with adverse outcomes has not been reported.

METHODS:

Transaortic FR was calculated from Doppler-derived stroke volume in milliliters divided by systolic ejection time in seconds and considered low if <200 ml/s. The association of transaortic FR with cardiovascular and all-cause mortality during 4.3-year follow-up was tested in time-varying Cox regression models run with aortic valve replacement as competing risk and reported as hazard ratio (HR) and 95% confidence interval (CI).

RESULTS:

Low transaortic FR was found in 21% of patients at baseline. Patients with low transaortic FR were older, had lower systemic arterial compliance and left ventricular mass, and included more women and patients with inconsistently graded severe AS and low stroke volume index (<35 ml/m2) (p < 0.01 for all). Low in-study transaortic FR was associated with higher rates of cardiovascular and all-cause mortality both in unadjusted analyses (HR: 2.56 [95% CI: 1.62 to 4.04]; and HR: 1.93 [95% CI: 1.35 to 2.75], respectively; p < 0.001 for both) and after adjustment for age, sex, randomized study treatment, hypertension, stroke volume index <35 ml/m2, LV mass, and mean aortic gradient (HR: 2.79 [95% CI: 1.65 to 4.73]; and HR: 1.90 [95% CI: 1.27 to 2.84], respectively; p < 0.01 for both).

CONCLUSIONS:

In patients with AS without known cardiovascular disease or diabetes, low transaortic FR was independently associated with higher rates of cardiovascular and all-cause mortality. (An Investigational Drug on Clinical Outcomes in Patients With Aortic Stenosis (Narrowing of the Major Blood Vessel of the Heart) (MK-0653A-043 AM4); NCT00092677).

• Authors: Sahrai Saeed, Roxy Senior, Navtej S Chahal, Mai Tone Lønnebakken, John B Chambers, Edda Bahlmann, Eva Gerdts
• Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging) Vol. 10 Issue 8 Pg. 912-920 (08 2017) ISSN: 1876-7591 [Electronic] United States
• PMID: 28797414 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anticholesteremic Agents
• Ezetimibe, Simvastatin Drug Combination
• Hydroxymethylglutaryl-CoA Reductase Inhibitors

Topics

• Aged
• Anticholesteremic Agents (therapeutic use)
• Aortic Valve (diagnostic imaging, drug effects, physiopathology)
• Aortic Valve Stenosis (diagnostic imaging, drug therapy, mortality, physiopathology)
• Chi-Square Distribution
• Echocardiography, Doppler
• Ezetimibe, Simvastatin Drug Combination (therapeutic use)
• Female
• Hemodynamics (drug effects)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Kaplan-Meier Estimate
• Logistic Models
• Male
• Middle Aged
• Nonlinear Dynamics
• Proportional Hazards Models
• Risk Factors
• Severity of Illness Index
• Time Factors
• Treatment Outcome