Impact of mean transaortic pressure gradient on long-term outcome in patients with severe aortic stenosis and preserved left ventricular ejection fraction

Background-mean transaortic pressure gradient (mtpg) has never been validated as a predictor of mortality in patients with severe aortic stenosis. we sought to determine the value of mtpg to predict mortality in a large prospective cohort of severe aortic stenosis patients with preserved left ventricular ejection fraction and to investigate the cutoff of 60 mm hg,proposed in american guidelines. methods and results-a total of 1143 patients with severe aortic stenosis defined by aortic valve area ≤1 cm2 and mtpg ≥40 mm hg were included. 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. the end point was all-cause mortality. mtpg was ≥60 mm hg in 392 patients. patients with mtpg ≥60 mm hg had a significantly increase risk of mortality compared with patients with mtpg >60 mm hg (hazard ratio [hr] =1.62 [1.27-2.05] p < 0.001),even for the subgroup of asymptomatic or minimally symptomatic patients (hr=1.56 [1.04-2.34] p=0.032). 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 [1.33-2.20] p < 0.001),even after adjusting for surgery as a timedependent variable (hr=1.71 [1.43-2.11] p < 0.001). similar results were observed for the subgroup of asymptomatic or minimally symptomatic patients (hr=1.70 [1.10-2.32] p=0.018 and hr=1.68 [1.20-2.36] p=0.003,respectively). conclusions-this study shows the negative prognostic impact of high mtpg (≥60 mm hg),on long-term outcome of patients with severe aortic stenosis with preserved left ventricular ejection fraction,irrespective of symptoms. © 2017 the authors.