European Journal of Echocardiography | 2021
Clinical value of stress transaortic flow rate during dobutamine echocardiography in low-gradient aortic stenosis
Abstract
\n \n \n Type of funding sources: None.\n BACKGROUND/INTRODUCTION\n The clinical value of rest transaortic flow rate (FR) has been shown previously in low-gradient aortic stenosis (LGAS) for the prediction of outcome. However limited data exists on the prognostic value of stress FR in LGAS following low-dose dobutamine stress echocardiography (LDDSE).\n \n \n \n We aimed to assess the value of stress FR in patients with LGAS in the diagnosis of AS severity and the prediction of mortality.\n \n \n \n This is a multi-centre cohort study of patients with low left ventricular ejection fraction (LVEF) and LGAS (aortic valve area –AVA <1cm²) who underwent LDDSE.\n \n \n \n Of the 287 patients (mean age:\xa0 75.1 ±10 years, males: 71%) over the mean follow-up of 24 ±30 months there were 127 (44.3%) deaths and 147 (51.2%) patients underwent aortic valve intervention. Lower stress FR was independently associated with increased risk of mortality (HR= 0.99, 95%CI= 0.99-0.999, p= 0.02) after adjusting for age, chronic kidney disease, presence of symptoms (NYHA II-IV), aortic valve intervention, rest LVEF and guideline-defined severe AS (AV mean gradient- AVMG ≥40mmHg with AVA <1cm² at peak stress).\xa0 The minimum cut-off for prediction of mortality was stress FR 210ml/sec. Among the different criteria of AS severity during stress, i.e. guideline-defined criterion, or stress AVMG ≥40mmHg, or stress AVA <1cm² at stress FR ≥210ml/s, only the latter was independently associated with mortality (HR= 1.81, 95%CI= 1.04-3.2, p= 0.04) (Table 1) and was the parameter of AS severity that predicted improved outcome following aortic valve intervention (p <0.005) (Figure 1). Guideline-defined stroke volume flow reserve did not predict mortality.\n \n \n \n Assessment of stress FR during LDDSE is important for the detection of both AS severity and flow reserve.\n Table 1 Multivariable analysis for prediction of all-cause mortality (N\u2009=\u2009287) for the different criteria of aortic stenosis HR 95%CI p Age 1 0.98-1.03 0.84 Chronic kidney disease 1..84 1.13-2.99 0.01 Aortic valve intervention 0.37 0.22-0.61 <0.005 Presence of symptoms (NYHA II-IV) 1.87 0.66-5.31 0.24 Rest LVEF (by 1%) increase 0.97 0.95-1 0.06 Stress AVA\u2009<\u20091cm² with stress AVMG≥40mmHg 1.02 0.31-3.34 0.97 Stress AVMG≥40mmHg 0.57 0.2-1.59 0.28 Stress AVA\u2009<\u20091cm² at stress FR≥210mmHg 1.81 1.04-3.2 0.04 Abstract Figure 1\n