RESUMEN
BACKGROUND: The association between aortic valve stenosis (AVS) and myocardial perfusion abnormalities has been incompletely characterized. We sought to assess the predictors of myocardial ischemia in patients with mild-to-moderate AVS, and its relationship with long-term prognosis. METHODS: Eighty-nine patients with mild-to-moderate AVS (peak velocity between 2.6-4.0 m/sec and aortic valve area >0.6 cm2/m2), preserved LV function and either normal coronary arteries (28 patients) or non-obstructive coronary artery disease (<50% stenosis; 61 patients) were individuated. Myocardial perfusion imaging (MPI) was performed with a Cadmium-Zinc-Telluride camera and the summed difference score (SDS) was computed. The presence of either left ventricular (LV) hypertrophy (LVH) [LV mass index (LVMI) >115 g/m2 (males) or 95 g/m2 (females)], or concentric LV remodeling (relative wall thickness >0.42) was determined at 2D-echocardiography. RESULTS: Forty (45%) and 49 (55%) patients had mild and moderate AVS, respectively. Fifty (56%), 17 (19%), and 22 (25%) patients had normal LV geometry, concentric LV remodeling, and LVH, respectively. An interaction between LV remodeling and inducible ischemia was revealed with progressively higher values of SDS in patients with normal LV geometry (3±3), concentric remodeling (4±2), and LVH (7±2) (P<0.001). Accordingly, a moderate correlation existed between LVMI and SDS values (R: 0.67; P<0.001). After a median follow-up of 84±47 months, 27 adverse events (AE) were recorded, including 19 AV replacements and 8 deaths. On multivariable analysis, the presence of LVH (HR: 6.46; 95%CI: 2.09-20.00; P=0.001) and a higher SDS (HR: 1.41; 95%CI: 1.15-1.75; P=0.001) were the two independent predictors of AE. CONCLUSIONS: In patients with mild-to-moderate AVS myocardial ischemia correlates with the severity of adverse LV remodeling. Patients with LVH and ischemia are at increased risk of AE.