• Marie-Annick Clavel, Christina Fuchs, Ian G Burwash, Gerald Mundigler, Jean G Dumesnil, Helmut Baumgartner, Jutta Bergler-Klein, Rob S Beanlands, Patrick Mathieu, Julien Magne, and Philippe Pibarot.
• Laval Hospital Research Center/Québec Heart Institute, Laval Hospital, 2725 Chemin Sainte-Foy, Québec, Quebec, Canada.
• Circulation. 2008 Sep 30;118(14 Suppl):S234-42.

BackgroundPatients with low-flow, low-gradient aortic stenosis have a poor prognosis with conservative therapy but a high operative mortality if treated surgically. Recently, we proposed a new index of aortic stenosis severity derived from dobutamine stress echocardiography, the projected aortic valve area at a normal transvalvular flow rate, as superior to other conventional indices to differentiate true-severe from pseudosevere aortic stenosis. The objective of this study was to identify the determinants of survival, functional status, and change in left ventricular ejection fraction during follow-up of patients with low-flow, low-gradient aortic stenosis.Methods And ResultsOne hundred one patients with low-flow, low-gradient aortic stenosis (aortic valve area ConclusionsIn patients with low-flow, low-gradient aortic stenosis, the most significant risk factors for poor outcome were (1) impaired functional capacity as measured by Duke Activity Status Index or 6-minute walk test distance; (2) more severe valve stenosis as measured by projected aortic valve area at a normal transvalvular flow rate; and (3) reduced peak stress left ventricular ejection fraction, a composite measure accounting for both resting left ventricular function and contractile reserve.

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