ABSTRACT
Introducción y objetivos. El pronóstico de los pacientes con estenosis aórtica grave con bajo gradiente aórtico y fracción de eyección normal es controvertido. Nuestro estudio analiza el pronóstico de estos pacientes y su relación con el gradiente de presión y el flujo valvular aórtico. Métodos. Cohorte retrospectiva de 363 pacientes consecutivos con estenosis aórtica grave y fracción de eyección normal, dividida en cuatro grupos según índice de volumen sistólico mayor o menor que 35 ml/m2 y gradiente aórtico medio mayor o menor que 40 mmHg. Grupo I, flujo normal y gradiente elevado (n = 169; 47%); grupo II, flujo normal y bajo gradiente (n = 98; 27%); grupo III, bajo flujo y gradiente elevado (n = 54; 15%), y grupo IV, bajo flujo y bajo gradiente (n = 42; 12%). El objetivo primario es la mortalidad total. Resultados. Los factores de riesgo independientes de mortalidad son la edad (hazard ratio = 1,04; intervalo de confianza del 95%, 1,01-1,08) y la fibrilación auricular (hazard ratio = 2,21; intervalo de confianza del 95%, 1,24-3,94). El tratamiento quirúrgico se asocia a mayor supervivencia en todos los grupos (hazard ratio = 0,25; intervalo de confianza del 95%, 0,13-0,49). Los pacientes con bajo flujo presentan mayor mortalidad que los pacientes con flujo normal (el 26,6 frente al 13,6%; p = 0,004). El grupo II muestra mejor pronóstico (hazard ratio = 0,4; intervalo de confianza del 95%, 0,2-0,9). Conclusiones. Los pacientes con estenosis aórtica grave, fracción de eyección normal y bajo flujo aórtico presentan peor pronóstico. El análisis del flujo aórtico mediante ecocardiografía Doppler es útil en la estratificación de riesgo y en la toma de decisiones terapéuticas en pacientes con estenosis aórtica (AU)
Introduction and objectives. The prognosis of patients with severe aortic stenosis, low aortic gradient and preserved ejection fraction is controversial. Our study analyzed the prognosis of these patients and its relation to pressure gradient and aortic valve flow. Methods. We performed a retrospective cohort study of 363 consecutive patients with severe aortic stenosis and preserved ejection fraction, divided into 4 groups, based on the presence of a systolic volume index greater or lower than 35mL/m2 and the presence of a mean aortic gradient greater or lower than 40mmHg. Group I: normal flow, high gradient (n=169, 47%); group II: normal flow, low gradient (n=98, 27%); group III: low flow, high gradient (n=54, 15%), and group IV: low flow, low gradient (n=42, 12%). The primary endpoint was overall mortality. Results. Independent risk factors for mortality were age (hazard ratio=1.04; 95% confidence interval, 1.01-1.08) and atrial fibrillation (hazard ratio=2.21; 95% confidence interval, 1.24-3.94). Surgical treatment was associated with longer survival in all groups (hazard ratio=0.25; 95% confidence interval: 0.13-0.49). Mortality was higher in patients with low flow than in those with with normal flow (26.6% vs 13.6%; P=.004). The most favorable mean prognosis was found in group II (hazard ratio=0.4; 95% confidence interval, 0.2-0.9). Conclusions. Patients with severe aortic stenosis, normal ejection fraction and low aortic flow have a worse prognosis. Analysis of aortic flow by Doppler echocardiography is useful in risk stratification and therapeutic decision-making in patients with aortic stenosis (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/diagnosis , Aortic Valve Stenosis/therapy , Echocardiography, Doppler/trends , Echocardiography, Doppler , Stroke Volume/physiology , Risk Factors , Aortic Valve Stenosis/physiopathology , Aortic Valve Stenosis , Stroke Volume , Cohort Studies , Retrospective StudiesABSTRACT
INTRODUCTION AND OBJECTIVES: The prognosis of patients with severe aortic stenosis, low aortic gradient and preserved ejection fraction is controversial. Our study analyzed the prognosis of these patients and its relation to pressure gradient and aortic valve flow. METHODS: We performed a retrospective cohort study of 363 consecutive patients with severe aortic stenosis and preserved ejection fraction, divided into 4 groups, based on the presence of a systolic volume index greater or lower than 35 mL/m(2) and the presence of a mean aortic gradient greater or lower than 40 mmHg. Group I: normal flow, high gradient (n=169, 47%); group II: normal flow, low gradient (n=98, 27%); group III: low flow, high gradient (n=54, 15%), and group IV: low flow, low gradient (n=42, 12%). The primary endpoint was overall mortality. RESULTS: Independent risk factors for mortality were age (hazard ratio=1.04; 95% confidence interval, 1.01-1.08) and atrial fibrillation (hazard ratio=2.21; 95% confidence interval, 1.24-3.94). Surgical treatment was associated with longer survival in all groups (hazard ratio=0.25; 95% confidence interval: 0.13-0.49). Mortality was higher in patients with low flow than in those with with normal flow (26.6% vs 13.6%; P=.004). The most favorable mean prognosis was found in group II (hazard ratio=0.4; 95% confidence interval, 0.2-0.9). CONCLUSIONS: Patients with severe aortic stenosis, normal ejection fraction and low aortic flow have a worse prognosis. Analysis of aortic flow by Doppler echocardiography is useful in risk stratification and therapeutic decision-making in patients with aortic stenosis.
Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Cardiac Volume , Stroke Volume , Aged , Aged, 80 and over , Aortic Valve Stenosis/classification , Cohort Studies , Echocardiography, Doppler , Female , Follow-Up Studies , Humans , Male , Prognosis , Retrospective StudiesABSTRACT
The authors describe the case of a 54-year-old woman with the association of two rare congenital cardiac anomalies: cor triatriatum and persistent left superior vena cava with the special characteristic of direct drainage to the right atrium. Real-time three-dimensional transesophageal echocardiography offered a comprehensive anatomic and functional evaluation of these infrequent entities.
Subject(s)
Cor Triatriatum/diagnostic imaging , Echocardiography, Three-Dimensional/methods , Echocardiography, Transesophageal/methods , Vena Cava, Superior/abnormalities , Vena Cava, Superior/diagnostic imaging , Female , Humans , Middle AgedABSTRACT
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Subject(s)
Humans , Female , Adult , Cardiac Tamponade/etiology , Pleural Effusion/complications , Hepatopulmonary Syndrome/complicationsABSTRACT
Left ventricular free wall rupture is an unusual but highly lethal complication of acute myocardial infarction. We report on the extremely rare occurrence of a patient surviving two episodes of free wall rupture within a seven-month period. The first event happened in the course of an exercise testing after a seemingly uncomplicated inferior acute myocardial infarction; the second, seven months after the first, as a pseudoaneurysm in the setting of a new inferior wall infarction. Surgical repair was successful in both instances, with patient remaining asymptomatic in follow-up.
