TABLE 4.
Characteristics of patients with low gradient low stroke volume index, low gradient normal stroke volume index, and high gradient severe aortic stenosis in the setting of normal left ventricular ejection fraction
| Low gradient low stroke volume index (n = 41) | Low gradient normal stroke volume index (n = 32) | High gradient stenosis (n = 229) | P-value | |
|---|---|---|---|---|
| Age, years | 84 [80–90] | 84 [78–89] | 84 [80–88] | 0.75 |
| Male sex | 22 (53.7%) | 19 (59.4%) | 117 (51.1%) | 0.67 |
| Race | 0.69 | |||
| White | 40 (97.6%) | 30 (93.8%) | 203 (89.0%) | |
| Black | 0 | 1 (3.1%) | 10 (4.4%) | |
| Asian | 0 | 0 | 3 (1.3%) | |
| Other | 1 (2.4%) | 1 (3.1%) | 12 (5.3%) | |
| Ethnicity | ||||
| Hispanic | 1 (2.4%) | 1 (3.1%) | 15 (6.6%) | 0.46 |
| Body mass index, kg/m2 | 26.8 [24.6–29.8] | 24.4 [22.2–27.3] | 26.6 [23.6–30.8] | 0.03 |
| History of tobacco use | 22 (56.4%) | 14 (43.8%) | 112 (50.0%) | 0.57 |
| Hypertension | 33 (80.5%) | 23 (71.9%) | 179 (78.2%) | 0.66 |
| Dyslipidemia | 32 (78.0%) | 21 (65.6%) | 174 (76.3%) | 0.39 |
| Diabetes mellitus | 18 (43.9%) | 7 (21.9%) | 70 (30.6%) | 0.11 |
| Prior myocardial infarction | 6 (15.0%) | 3 (9.4%) | 17 (7.5%) | 0.29 |
| Prior cardiac surgery | 12 (29.3%) | 8 (25.0%) | 58 (25.4%) | 0.87 |
| Prior surgical aortic valve replacement | 1 (2.5%) | 2 (6.3%) | 14 (6.2%) | 0.64 |
| Congestive heart failure | 35 (85.4%) | 28 (87.5%) | 197 (86.4%) | 0.97 |
| Chronic lung disease | 10 (24.4%) | 8 (25.0%) | 57 (25.1%) | 0.99 |
| Atrial arrhythmia | 22 (53.7%) | 8 (25.0%) | 65 (28.5%) | 0.004 |
| Prior permanent pacemaker placement | 7 (17.1%) | 5 (15.6%) | 26 (11.5%) | 0.53 |
| Prior stroke or transient ischemic attack | 9 (22.0%) | 7 (21.9%) | 26 (11.4%) | 0.08 |
| Chronic renal insufficiency | 24 (61.5%) | 13 (41.9%) | 108 (48.6%) | 0.22 |
| Number of native coronary arteries diseased | 0.64 | |||
| 0 | 17 (45.9%) | 19 (59.4%) | 128 (60.4%) | |
| 1 | 12 (32.4%) | 6 (18.8%) | 39 (18.4%) | |
| 2 | 3 (8.1%) | 3 (9.4%) | 18 (8.5%) | |
| 3 | 5 (13.5%) | 4 (12.5%) | 27 (12.7%) | |
| Society of Thoracic Surgery predicted 30-day mortality risk, % | 6.3 [3.8–8.1] | 6.0 [4.3–8.1] | 5.7 [4.1–7.4] | 0.74 |
| Aortic valve peak velocity, m/sec | 3.5 [3.2–3.7] | 3.6 [3.4–3.8] | 4.3 [4.1–4.7] | <0.001 |
| Mean gradient, mmHg | 26 [22–31] | 30 [25–31] | 44 [40–55] | <0.001 |
| Aortic valve area, cm2 | 0.70 [0.66–0.80] | 0.83 [0.75–0.91] | 0.70 [0.57–0.80] | <0.001 |
| Left ventricular ejection fraction, % | 65 [60–70] | 65 [60–70] | 65 [60–70] | 0.92 |
| Left ventricular end-diastolic dimension, cm | 4.1 [3.9–4.8] | 4.2 [3.4–4.6] | 4.2 [3.7–4.7] | 0.69 |
| Left ventricular end-systolic diameter, cm | 2.9 [2.4–3.4] | 2.6 [2.2–3.0] | 2.8 [2.4–3.1] | 0.09 |
| Interventricular septum thickness, cm | 1.3 [1.1–1.5] | 1.4 [1.2–1.5] | 1.3 [1.2–1.5] | 0.86 |
| Posterior/inferolateral wall thickness, cm | 1.2 [1.0–1.3] | 1.2 [1.1–1.3] | 1.2 [1.1–1.3] | 0.26 |
| Aortic regurgitation (moderate or severe), % | 2 (4.9%) | 4 (12.5%) | 20 (8.7%) | 0.51 |
| Mitral regurgitation (moderate or severe), % | 11 (26.8%) | 5 (15.6%) | 31 (13.5%) | 0.10 |
| Mitral stenosis (severe), % | 0 | 0 | 7 (3.3%) | 0.33 |
| Tricuspid regurgitation (severe), % | 2 (4.9%) | 0 | 4 (1.7%) | 0.29 |
| Aortic root, cm | 3.1 [2.9–3.3] | 3.0 [2.8–3.4] | 3.1 [2.8–3.4] | 0.70 |
| Procedure status, % | ||||
| Elective | 40 (97.6%) | 31 (96.9%) | 218 (95.2%) | 0.74 |
| Urgent | 1 (2.4%) | 1 (3.1%) | 11 (4.8%) | |
| Emergency/Salvage | 0 | 0 | 0 | |
| Access, % | 0.02 | |||
| Transfemoral | 40 (97.6%) | 30 (93.8%) | 228 (99.6%) | |
| Transapical | 1 (2.4%) | 1 (3.1%) | 1 (0.4%) | |
| Subclavian | 0 | 1 (3.1%) | 0 | |
| Anesthesia, % | 0.12 | |||
| Monitored anesthesia care | 36 (87.8%) | 25 (78.1%) | 207 (90.4%) | |
| General anesthesia | 5 (12.2%) | 7 (21.9%) | 22 (9.6%) | |
| Device, % | 0.06 | |||
| 1st generation self-expanding valve | 13 (31.7%) | 8 (25.0%) | 61 (26.6%) | |
| 2nd generation self-expanding valve | 16 (39.0%) | 18 (56.3%) | 115 (50.2%) | |
| 1st generation balloon-expandable valve | 5 (12.2%) | 4 (12.5%) | 8 (3.5%) | |
| 2nd generation balloon—expandable valve | 7 (17.1%) | 2 (6.3%) | 45 (19.7%) | |
| Predilation, % | 11 (26.8%) | 5 (16.1%) | 75 (32.8%) | 0.15 |
| Postdilation, % | 9 (22.0%) | 11 (35.5%) | 98 (42.8%) | 0.04 |
Continuous data shown as median [interquartile range] and compared using Kruskal-Wallis test. Categorical data shown as frequency (proportion) and compared using tests of proportions