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Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study

BACKGROUND AND OBJECTIVES: Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS....

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Autores principales: Kim, Kyu, Cho, Iksung, Ko, Kyu-Yong, Lee, Seung-Hyun, Lee, Sak, Hong, Geu-Ru, Ha, Jong-Won, Shim, Chi Young
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Cardiology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654414/
https://www.ncbi.nlm.nih.gov/pubmed/37653715
http://dx.doi.org/10.4070/kcj.2023.0022
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author Kim, Kyu
Cho, Iksung
Ko, Kyu-Yong
Lee, Seung-Hyun
Lee, Sak
Hong, Geu-Ru
Ha, Jong-Won
Shim, Chi Young
author_facet Kim, Kyu
Cho, Iksung
Ko, Kyu-Yong
Lee, Seung-Hyun
Lee, Sak
Hong, Geu-Ru
Ha, Jong-Won
Shim, Chi Young
author_sort Kim, Kyu
collection PubMed
description BACKGROUND AND OBJECTIVES: Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS. METHODS: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m(2), mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm(2)) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization. RESULTS: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29–0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23–1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19–0.95, p=0.037). Subgroup analyses supported the main findings. CONCLUSIONS: An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS. Future randomized studies are required to validate and confirm our findings.
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spelling pubmed-106544142023-11-01 Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study Kim, Kyu Cho, Iksung Ko, Kyu-Yong Lee, Seung-Hyun Lee, Sak Hong, Geu-Ru Ha, Jong-Won Shim, Chi Young Korean Circ J Original Research BACKGROUND AND OBJECTIVES: Aortic valve replacement (AVR) is considered a class I indication for symptomatic severe aortic stenosis (AS). However, there is little evidence regarding the potential benefits of early AVR in symptomatic patients diagnosed with normal-flow, low-gradient (NFLG) severe AS. METHODS: Two-hundred eighty-one patients diagnosed with symptomatic NFLG severe AS (stroke volume index ≥35 mL/m(2), mean transaortic pressure gradient <40 mmHg, peak transaortic velocity <4 m/s, and aortic valve area <1.0 cm(2)) between January 2010 and December 2020 were included in this retrospective study. After performing 1:1 propensity score matching, 121 patients aged 75.1±9.8 years (including 63 women) who underwent early AVR within 3 months after index echocardiography, were compared with 121 patients who received conservative care. The primary outcome was a composite of all-cause death and heart failure (HF) hospitalization. RESULTS: During a median follow-up of 21.9 months, 48 primary outcomes (18 in the early AVR group and 30 in the conservative care group) occurred. The early AVR group demonstrated a significantly lower incidence of primary outcomes (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.29–0.93; p=0.028); specifically, there was no significant difference in all-cause death (HR, 0.51; 95% CI, 0.23–1.16; p=0.110), although the early AVR group showed a significantly lower incidence of hospitalization for HF (HR, 0.43; 95% CI, 0.19–0.95, p=0.037). Subgroup analyses supported the main findings. CONCLUSIONS: An early AVR strategy may be beneficial in reducing the risk of a composite outcome of death or hospitalization for HF in symptomatic patients with NFLG severe AS. Future randomized studies are required to validate and confirm our findings. The Korean Society of Cardiology 2023-08-01 /pmc/articles/PMC10654414/ /pubmed/37653715 http://dx.doi.org/10.4070/kcj.2023.0022 Text en Copyright © 2023. The Korean Society of Cardiology https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Kim, Kyu
Cho, Iksung
Ko, Kyu-Yong
Lee, Seung-Hyun
Lee, Sak
Hong, Geu-Ru
Ha, Jong-Won
Shim, Chi Young
Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study
title Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study
title_full Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study
title_fullStr Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study
title_full_unstemmed Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study
title_short Early Aortic Valve Replacement in Symptomatic Normal-Flow, Low-Gradient Severe Aortic Stenosis: A Propensity Score–Matched Retrospective Cohort Study
title_sort early aortic valve replacement in symptomatic normal-flow, low-gradient severe aortic stenosis: a propensity score–matched retrospective cohort study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654414/
https://www.ncbi.nlm.nih.gov/pubmed/37653715
http://dx.doi.org/10.4070/kcj.2023.0022
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