Concomitant mitral regurgitation in patients with low-gradient aortic stenosis: an analysis from the German Aortic Valve Registry.

Content Provider	Europe PMC
Author	Alushi, Brunilda Ensminger, Stephan Herrmann, Eva Balaban, Ümniye Bauer, Timm Beckmann, Andreas Bleiziffer, Sabine Möllmann, Helge Walther, Thomas Bekeredjian, Raffi Hamm, Christian Beyersdorf, Friedhelm Baldus, Stephan Boening, Andreas Falk, Volkmar Thiele, Holger Frerker, Christian Lauten, Alexander
Abstract	BackgroundPatients with severe aortic stenosis (AS) frequently presented mitral regurgitation (MR), which may interfere with the standard echocardiographic measurements of mean pressure gradient (MPG), flow velocity, and aortic valve area (AVA).AimsHerein we investigated the prevalence and severity of MR in patients with severe AS and its role on the accuracy of the standard echocardiographic parameters of AS quantification.MethodsOf all patients with severe AS undergoing transcatheter or surgical aortic valve replacement enrolled in the German Aortic Registry from 2011 to 2017, 119,641 were included in this study. The population was divided based on the values of left ventricular ejection fraction ([LVEF] > 50%, LVEF 31–50%, and LVEF ≤ 30%] and AVA (0.80 to ≤ 1.00 cm2, 0.60 to < 0.80 cm2, 0.40 to < 0.60 cm2, and 0.20 to < 0.40 cm2).ResultsOverall, 77,890 (65%) patients with mild to-moderate and 4262 (4%) with severe MR were compared with 37,489 (31%) patients without MR. Patients with mild-to-moderate and severe MR presented significantly lower mPG (ΔmPG [95%CI] − 1.694 mmHg [− 2.123 to − 1.265], p < 0.0001 and − 6.954 mmHg [− 7.725 to − 6.183], p < 0.0001, respectively), that increased with LVEF impairment. Conversely, AVA did not differ (severe versus no MR: ΔAVA [95%CI]: − 0.007cm2 [− 0.023 to 0.009], p = 0.973). Increasing MR severity was associated with significant mPG reduction throughout all AVA strata, causing a low-gradient pattern, that manifested since the early stages of severe AS (LVEF > 50%: AVA 0.80 to 1.00 cm2; LVEF 31–50%: AVA 0.60 to 0.80 cm2).ConclusionsIn patients with severe AS, concomitant MR is common, contributes to the onset of a low-gradient AS pattern, and affects the diagnostic accuracy of flow-dependent AVA measurements. In this setting, a multimodality, AVA-centric approach should be implemented.Graphical abstractIn patients with severe aortic stenosis, concomitant mitral regurgitation contributes to the onset of a low-gradient pattern, warranting a multimodality, and AVA-centric diagnostic approach.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00392-022-02067-2.
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ISSN	18610684
Journal	Clinical Research in Cardiology [Clin Res Cardiol]
Volume Number	111
DOI	10.1007/s00392-022-02067-2
PubMed Central reference number	PMC9681685
Issue Number	12
PubMed reference number	35984497
e-ISSN	18610692
Language	English
Publisher	Springer Berlin Heidelberg
Publisher Date	2022-08-19
Publisher Place	Berlin/Heidelberg
Access Restriction	Open
Rights License	Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. © The Author(s) 2022
Subject Keyword	Aortic stenosis Mitral regurgitation Paravalvular leak TAVI MSCT Transthoracic echocardiogram
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine