TY - JOUR
T1 - Concomitant mitral regurgitation and aortic stenosis
T2 - One step further to low-flow preserved ejection fraction aortic stenosis
AU - Benfari, Giovanni
AU - Clavel, Marie Annick
AU - Nistri, Stefano
AU - Maffeis, Caterina
AU - Vassanelli, Corrado
AU - Enriquez-Sarano, Maurice
AU - Rossi, Andrea
N1 - Publisher Copyright:
© 2017 The Author.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Aims Patients with severe aortic stenosis (AS) and normal ejection fraction (EF) can paradoxically present low-transaortic flow and worse prognosis. The role of co-existing mitral regurgitation (MR) in determining this haemodynamic inconsistency has never been quantitatively explored. The hypothesis is that MR influences forward stroke volume and characterizes the low-flow AS pattern. Methods and results Consecutive patients with indexed aortic valve area (AVA) ≤0.6 cm 2/m 2 and EF > 50% formed the study population. Complete echocardiographic data were collected, and mitral effective regurgitant orifice area (ERO) and regurgitant volume were obtained with proximal isovelocity surface area method. Patients were divided into subgroups according to indexed stroke volume (SV index). Included patients were 273 [age 79 ± 10 years, 53% female, EF 65 ± 7%, indexed AVA 0.47 ± 0.09 cm 2/m 2, mean transaortic gradient (MG) 32 ± 17 mmHg]. Mitral regurgitation was present in 89 (32%); ERO was 0.12 ± 0.08 cm 2 (range 0.02-0.49 cm 2). A low-flow state (SV index ≤35 mL/m 2) was diagnosed in 41 (15%) patients. The prevalence of MR was higher in with low-flow vs. normal-flow group (56 vs. 28%, P = 0.03). Effective regurgitant orifice was associated to low-flow state univariately (OR: 1.75 [1.59-2.60]; P = 0.004) and after comprehensive adjustment (OR:1.76 [1.12-2.75]; P = 0.01). When MG was forced in the model, ERO remained significant (P < 0.009). On average, there was a 6 mL reduction in forward SV appeared per each 0.1 cm 2 of ERO. Conclusion In patients with severely reduced AVA and preserved EF, MR is a major determinant of the low-flow condition. Furthermore, MR quantification by ERO predicts the presence of reduced flow independently of chamber volumes, systolic function, and transaortic gradient.
AB - Aims Patients with severe aortic stenosis (AS) and normal ejection fraction (EF) can paradoxically present low-transaortic flow and worse prognosis. The role of co-existing mitral regurgitation (MR) in determining this haemodynamic inconsistency has never been quantitatively explored. The hypothesis is that MR influences forward stroke volume and characterizes the low-flow AS pattern. Methods and results Consecutive patients with indexed aortic valve area (AVA) ≤0.6 cm 2/m 2 and EF > 50% formed the study population. Complete echocardiographic data were collected, and mitral effective regurgitant orifice area (ERO) and regurgitant volume were obtained with proximal isovelocity surface area method. Patients were divided into subgroups according to indexed stroke volume (SV index). Included patients were 273 [age 79 ± 10 years, 53% female, EF 65 ± 7%, indexed AVA 0.47 ± 0.09 cm 2/m 2, mean transaortic gradient (MG) 32 ± 17 mmHg]. Mitral regurgitation was present in 89 (32%); ERO was 0.12 ± 0.08 cm 2 (range 0.02-0.49 cm 2). A low-flow state (SV index ≤35 mL/m 2) was diagnosed in 41 (15%) patients. The prevalence of MR was higher in with low-flow vs. normal-flow group (56 vs. 28%, P = 0.03). Effective regurgitant orifice was associated to low-flow state univariately (OR: 1.75 [1.59-2.60]; P = 0.004) and after comprehensive adjustment (OR:1.76 [1.12-2.75]; P = 0.01). When MG was forced in the model, ERO remained significant (P < 0.009). On average, there was a 6 mL reduction in forward SV appeared per each 0.1 cm 2 of ERO. Conclusion In patients with severely reduced AVA and preserved EF, MR is a major determinant of the low-flow condition. Furthermore, MR quantification by ERO predicts the presence of reduced flow independently of chamber volumes, systolic function, and transaortic gradient.
KW - aortic valve stenosis
KW - low flow
KW - mitral regurgitation
KW - quantification
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U2 - 10.1093/ehjci/jex172
DO - 10.1093/ehjci/jex172
M3 - Article
C2 - 28950322
AN - SCOPUS:85047093815
SN - 2047-2404
VL - 19
SP - 569
EP - 573
JO - European heart journal cardiovascular Imaging
JF - European heart journal cardiovascular Imaging
IS - 5
ER -