454 Mitral regurgitation and in-hospital mortality in patients with heart failure and low flow low gradient aortic stenosis. (8th December 2021)

• Record Type: Journal Article
• Authors: Ferruzzi, Germano Junior; Peluso, Angela Pamela; Attisano, Tiziana; Migliarino, Serena; Vigorito, Francesco; Bellino, Michele; Iuliano, Giuseppe; Silverio, Angelo; Provenza, Gennaro; Cristiano, Mario; Baldi, Cesare; Ciccarelli, Michele; Galasso, Gennaro; Vecchione, Carmine; Citro, Rodolfo
• Is Part Of: European heart journal supplements. Volume 23(2021)Supplement G
• Publication Date: 2021-12-08
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/suab132.011
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: Aims: This study sought to determine the prevalence, clinical impact, and in-hospital outcome of moderate to severe mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) hospitalized for heart failure (HF). Methods and results: Patients with aortic valve thickness and aortic velocities >2.5 m/s hospitalized for heart failure in a single referral centre were prospectively enrolled from 2013 to 2021. LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm 2 /m 2, mean transaortic gradient <40 mmHg, and stroke volume index <36 ml/m 2 . Complete demographic, clinical characteristics, and echocardiographic data were collected. Mitral regurgitation severity was graded according to current guidelines. Patients were divided into two subgroups according to MR severity: no/mild MR vs. moderate/severe MR. In hospital all cause death has been considered as the primary outcome. A total of 136 patients [78 ± 9 yy; 68 (50%) male] hospitalized for HF with a new diagnosis of LFLG-AS were included in the study. The most frequent comorbidities were hypertension (121, 89%), dyslipidemia (106, 78%), chronic kidney disease (85, 63%), diabetes (56, 41%), and obesity (44, 32%). Atrial fibrillation/flutter was detected in 61 (45%) patients. Moderate to severe MR was detected in 33%. Mean functional NYHA class was 2.8 ± 0.8. Concerning echocardiographic evaluation, the mean gradient of the aortic valve was 26 ± 7 mmHg and the mean iAVA was 0.42 ± 0.10 cm 2 /m 2 . The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. Paradoxical LFLG-AS with a preserved LV EF was detected in 73 patients (54%) and the LFLG-AS with a low LV EF was detected in 63 (46%). In this population, 26 patients (19%) underwent surgical valvular replacement, 15 patients (11%) had aortic percutaneous valvuloplasty, and 33 patients (24%) underwent TAVI. The remaining patients (45%, n = 62) were maintained under optimized medical therapy. In-hospital death occurred in 17 (12.5%) patients (just 1 for non-cardiovascular causes). Moderate/severe MR was detected in 44 (33%) patients. When comparing the two subgroups statistically significant differences between age ( P = 0.035), male sex ( P = 0.028), atrial fibrillation/flutter ( P = 0.003), obesity ( P = 0.040), and in-hospital mortality ( P = 0.013) were detected. In the overall population the multivariate regression analysis showed that only the presence of moderate/severe MR was a significant independent predictor of all-cause in-hospital death ( P = 0.017; OR: 3.571; CI: 1.257–10.151). Conclusions: Moderate to severe MR is frequently detected in patients with LFLG AS and HF. In this peculiar cohort significant MR has a negative impact on outcome and is independently associated with in-hospital mortality.