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Erschienen in: The International Journal of Cardiovascular Imaging 3/2020

27.11.2019 | Original Paper

Clinical and echocardiographic features of paradoxical low-flow and normal-flow severe aortic stenosis patients with concomitant mitral regurgitation

verfasst von: Jinghao Nicholas Ngiam, Nicholas Chew, Rebecca Teng, Jonathan D. Kochav, Stephanie M. Kochav, Benjamin Yong-Qiang Tan, Hui Wen Sim, Ching-Hui Sia, William K. F. Kong, Edgar Lik Wui Tay, Tiong-Cheng Yeo, Kian-Keong Poh

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 3/2020

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Abstract

Mitral regurgitation (MR) coexists in a significant proportion of patients with severe aortic stenosis (AS), and portends inferior therapeutic outcomes. In severe AS, MR is thought to contribute to a low-flow state by decreasing forward stroke volume. We investigated concomitant MR on the clinical and echocardiographic features of patients with “paradoxical” low-flow (PLF) and normal-flow (NF) severe AS. Clinical and echocardiographic profiles of 886 consecutive patients with index echocardiographic diagnosis of severe AS (AVA < 1.0 cm2) were analysed retrospectively. All patients had preserved ejection fraction (LVEF  ≥ 50%, n = 645), and were divided into PLF (stroke volume index, SVI < 35 mL/m2) and NF AS. They were then further subdivided based on the presence or absence of moderate-or-severe MR (msMR). A higher prevalence of concomitant msMR was observed in patients with PLF AS (14.9%; n = 33/221) compared to those with NF AS (8.0%; n = 34/424). Concomitant msMR was associated with echocardiographic features of increased diastolic dysfunction in both PLF AS and NF AS patients, as evidenced by increased LA diameter (PLF AS 52.9 ± 12.5 to 43.9 ± 8.9 mm; NF AS 29.6 ± 10.8 to 42.4 ± 8.8 mm; p < 0.001) and increased transmitral E/A ratio (PLF AS 1.26 ± 0.56 to 0.92 ± 0.43; NF AS 1.19 ± 0.63 to 0.94 ± 0.45; p = 0.004). Amongst patients with NF AS, msMR was additionally associated with increased E:e’ ratio (25.5 ± 15.1 vs 19.3 ± 10.8; p = 0.025). Concomitant MR was more common in PLF AS compared to NF. Although possibly related to the MR, patients severe AS and MR appeared to have more severe diastolic dysfunction. Further studies are warranted to evaluate prognosis and guide management.
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Metadaten
Titel
Clinical and echocardiographic features of paradoxical low-flow and normal-flow severe aortic stenosis patients with concomitant mitral regurgitation
verfasst von
Jinghao Nicholas Ngiam
Nicholas Chew
Rebecca Teng
Jonathan D. Kochav
Stephanie M. Kochav
Benjamin Yong-Qiang Tan
Hui Wen Sim
Ching-Hui Sia
William K. F. Kong
Edgar Lik Wui Tay
Tiong-Cheng Yeo
Kian-Keong Poh
Publikationsdatum
27.11.2019
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 3/2020
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-019-01735-1

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