ABSTRACT
Introduction Background: the best management of symptomatic patients with low gradient (LG) severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) has not been established in randomized controlled trials. The ROTAS trial aimed to assess the superiority of aortic valve replacement (AVR) versus optimized medical therapy (OMT) in symptomatic patients with LG severe AS and preserved LVEF. Method Fifty-two patients (age 79±7 years;males 46%, mean aortic gradient: 31±5mmHg;aortic surface: 0.8±0.1cm2) who were randomized 1:1 to AVR or OMT. The follow-up lasted 14±7 months. The study was interrupted early because of the low inclusion rate during the COVID-2019 pandemic. The AS severity was confirmed by a multimodality approach including dobutamine stress echocardiography and/or aortic calcium score. The primary end-point (overall death and/or hospitalisation for heart failure) occurred in 13 (25%) patients. Results Patients undergoing AVR showed a similar recurrence of events (overall death, heart failure hospitalisation) compared to patients receiving OMT (5 vs. 8 events). Patients receiving OMT did not experience worse survival compared to patients receiving AVR (HR 1.57, 95% CI: 0.51–4.83, P=0.4275). Kaplan-Meier curves showed similar event-free survival (logrank P=0.4236) among the 2 groups (Fig. 1). Conclusion In the randomized ROTAS trial, AVR is not associated with a better prognosis in symptomatic patients with LG severe AS and preserved LVEF. .
ABSTRACT
Introduction: Although cardiac involvement has prognostic significance in COVID-19 and is associated with severe presentations, few studies have explored the prognostic role of transthoracic echocardiography (TTE). We investigated the link between TTE parameters and prognosis in COVID-19. Method: Consecutive patients with COVID-19 admitted in 24 French hospitals were retrospectively included. Comprehensive data, including clinical and biological parameters, were recorded at admission. Focused TTE was performed during hospitalization, according to clinical indication. Patients were followed-up for a primary composite outcome of death or transfer to intensive care unit (ICU) during hospitalization. Results: Among 2878 patients, 445 (15%) underwent TTE. Most had cardiovascular risk factors, a history of cardiovascular disease, and were under cardiovascular medications. Dilatation and dysfunction were observed in12% (48/412) and 23% (102/442) of patients for the left ventricle, and in 12% (47/407) and 16% (65/402) for the right ventricle (RV), respectively. Primary composite outcome occurred in 44% (n = 196) of patients (9% [n = 42] for death without ICU transfer and 35% [n = 154] for admission to ICU). RV dilatation was the only TTE parameter associated with the primary outcome. After adjustment, male sex (hazard ratio [HR] 1.56, 95% CI 1.09 − 2.25;P = 0.02), higher body mass index (HR 1.10, 95% CI 1.02 − 1.18;P = 0.01), anticoagulation (HR 0.53, 95% CI 0.33 − 0.86;P = 0.01), and RV dilatation (HR 1.66, 95% CI 1.05 − 2.64;P = 0.03) remained independently associated with the primary outcome (Fig. 1). Conclusion: Echocardiographic evaluation of RV dilatation could be useful for assessing the risk of inhospital death or transfer to ICU in severe hospitalized COVID-19 patients.