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Classic Clarity, Paradoxical Puzzle: Prognostic evaluation in Low Flow Low Gradient Aortic Stenosis after transcatheter aortic valve replacement
Session:
SESSÃO DE POSTERS 34 - TAVI 2
Speaker:
Tatiana Pereira Dos Santos
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Tatiana Pereira Dos Santos; Mariana Rodrigues Simões; Ana L. Silva; Gonçalo Terleira Batista; Rafaela Fernandes; Tomás M. Carlos; Bernardo Lisboa Resende; Luísa Gomes Rocha; Mafalda Griné; Elisabete Jorge; Marco Costa; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos"><span style="color:#000000">Introduction: In severe aortic stenosis (AS), patients with reduced ejection fraction have worse prognosis than those with preserved ejection fraction. Paradoxical AS is defined as severe AS with an aortic valve area (AVA)<1.0 cm², mean gradient (MG) <40 mmHg, indexed systolic volume (SVi) ≤35 ml/m², and preserved left ventricular ejection fraction (LVEF≥50%).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos"><span style="color:#000000">Methods: Retrospective analysis of patients undergoing transcatheter aortic valve replacement (TAVR) for severe AS (March 2020-December 2023) at a tertiary hospital, with a median follow-up of 777 (IQR 579) days. The main objective was to compare patients with paradoxical low flow, low gradient (paradoxical LFLG) and classic low flow, low gradient (classic LFLG) with reduced ejection fraction (LVEF < 50%).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos"><span style="color:#000000">Results: Of 719 TAVR patients, 52 (7.3%) were treated for paradoxical LFLG, and 68 (9.5%) for classic LFLG. The paradoxical LFLG group was 53.8% male with a median age of 84 years (IQR 7), whereas the classic LFLG group was 69.1% male with a median age of 82 years (IQR 9). Age distribution differed significantly (p=0.001), with paradoxical LFLG patients being older. No gender difference was found. Regarding cardiovascular (CV) risk factors: 25.0%vs.42.6% (p=0.054) had diabetes, 75.0%vs.61.8% (p=0.132) had dyslipidemia, 90.4%vs.79.4% (p=0.169) had hypertension, and 7.7%vs.19.1% (p=0.112) were smokers in paradoxical LFLG and classic LFLG, respectively, with no significant difference. Also, 9.6%vs.19.1% (p=0.199) had a history of myocardial infarction, 5.8%vs.10.3% (p=0.51) of stroke. Univariate analysis showed that the classic LFLG group was associated with more renal disease (OR 2.4, 95% CI 1.1-5.2, p=0.017) and acute congestive heart failure (OR 1.9, 95% CI 1.2-3.2, p=0.007), but after multivariate analysis, lost its significance. Both groups had similar rates of major adverse events, like stroke or myocardial infarction. Kaplan-Meier curves showed comparable all-cause mortality between the two groups. Survival at 12 months was 94.2% for paradoxical LFLG and 89.6% for classic LFLG, with no significant difference (p=0.705). At three years, survival curves also showed no significant differences.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos"><span style="color:#000000">Conclusion: Patients with paradoxical AS undergo TAVR at an older age than those with classic AS, likely due to delayed diagnosis. The similar mortality outcomes suggest that TAVR provides a prognostic benefit, with both groups sharing the same mortality risk despite different pathophysiological features.</span></span></span></p>
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