4/30/2023 0 Comments Gradient meaning![]() ![]() A comorbidity index comprising the sum of the patient's individual comorbidities was calculated. Patients with atypical chest pain and elderly patients with minimal dyspnea not clearly related to AS were considered to be minimally symptomatic. Symptoms were ascertained by each patient's personal cardiologist. We subsequently carried out subgroup analyses on the asymptomatic or minimally symptomatic SAS population (n=559). Patients were retrospectively divided into 3 groups according to their baseline MTPG: Group 1 included patients with MTPG between 40 and 49 mm Hg group 2 included patients with MTPG between 50 and 59 mm Hg and group 3 included patients with MTPG ≥60 mm Hg. The present analysis focused on 1143 patients with severe AS defined by AVA ≤1 cm 2 and/or AVA normalized to body surface area (BSA) ≤0.6 cm 2/m 2 and MTPG ≥40 mm Hg. ![]() The following patients were excluded: (1) patients with more than mild aortic and/or mitral regurgitation (2) patients with prosthetic valves, congenital heart disease (with the exception of bicuspid aortic valves), supravalvular or subvalvular AS, or dynamic LV outflow tract obstruction and (3) patients who refused to participate in the study. The aims of the study were 2‐fold: (1) to evaluate the prognostic impact of MTPG on all‐cause mortality in a large cohort of SAS patients with preserved LVEF, and in a subroup of asymptomatic or minimally symptomatic patients, and (2) to evaluate the cut‐off of 60 mm Hg defined by American guidelines to predict mortality in these 2 populations.īetween 20, patients aged ≥18 years diagnosed with ≥ mild AS (aortic valve calcification with restricted systolic motion and AVA <2 cm 2) and LVEF ≥50% were prospectively identified and included in an electronic database. The present study included consecutive patients diagnosed with SAS in the echocardiography laboratories of 2 French tertiary centers (Amiens and Lille). However, MTPG has never been validated as a predictor of outcome in SAS. ![]() There is an excellent correlation between MTPG measured by continuous‐wave Doppler and mean gradient measured by catheter, 4 which make it one of the most powerful markers of the severity of AS provided cardiac output is normal and LVEF is preserved. This cut‐off of 60 mm Hg, defined by American guidelines, is based on expert opinion, but is not supported by scientific evidence. 2 In comparison, European Society of Cardiology guidelines define very severe aortic stenosis as Vmax >5.5 m/s 1 with no reference to MTPG. The American College of Cardiology/American Heart Association guidelines define “very severe aortic stenosis” when Vmax is ≥5 m/s and/or when MTPG is ≥60 mm Hg. 3 The management of asymptomatic patients with SAS by either conservative treatment or aortic valve replacement remains controversial. For example, the current definition of severe aortic valve stenosis includes an aortic valve area (AVA) 40 mm Hg, or aortic maximal velocity (Vmax) >4.0 m/s 1 introducing somewhat lower MTPG cutoff values for severe stenosis compared with the previous values of AVA ≤1.0 cm 2 and MTPG >50 mm Hg. 1, 2 The cutoff values for grading the severity of aortic valve stenosis have been changed. ![]() Elective surgery is recommended for severe symptomatic aortic stenosis (AS) and for some groups of asymptomatic individuals with SAS and preserved left ventricular (LV) ejection fraction (LVEF). Severe aortic stenosis (SAS) constitutes a public health issue with a serious impact for healthcare providers. Similar results were observed for the subgroup of asymptomatic or minimally symptomatic patients ( HR=1.70 P=0.018 and HR=1.68 P=0.003, respectively). After adjustment for established outcome predictors, patients with MTPG ≥60 mm Hg had a significantly higher risk of mortality than patients with MTPG <60 mm Hg ( HR=1.71 P<0.001), even after adjusting for surgery as a time‐dependent variable ( HR=1.71 P<0.001). Patients with MTPG ≥60 mm Hg had a significantly increase risk of mortality compared with patients with MTPG <60 mm Hg (hazard ratio =1.62 P<0.001), even for the subgroup of asymptomatic or minimally symptomatic patients ( HR=1.56 P=0.032). The population was divided into 3 groups according to MTPG: between 40 and 49 mm Hg, between 50 and 59 mm Hg, and ≥60 mm Hg.
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