Myocardial Contractile Reserve and Mortality in Patients with Severe Aortic Stenosis with Impaired Left Ventricular Function Who Underwent Transcatheter Aortic Valve Implantation.

Low-flow, low-gradient aortic stenosis (LFLG AS) with reduced left ventricular ejection fraction (LVEF) remains a challenging subgroup of severe AS. In these patients, dobutamine stress echocardiography (DSE) is routinely used to establish the diagnosis of true severe AS. The 2014 ACC/AHA Valve Guidelines endorse a class IIa recommendation for low‐dose DSE in AS patients with LVEF <50% to confirm AS severity and to assess myocardial contractile reserve (CR), which is defined as stroke volume increase of ≥20%. Earlier studies have shown that patients with LFLG AS and no CR have increased mortality with conservative management as well as with surgical aortic valve replacement (SAVR). 1 Monin JL Quere JP Monchi M Petit H Baleynaud S Chauvel C Pop C Ohlmann P Lelguen C Dehant P Tribouilloy C Gueret P Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003; 108: 319-324 Crossref PubMed Scopus (445) Google Scholar However, it is not known if CR portends similar prognostic significance in patients who underwent transcatheter aortic valve implantation (TAVI). Hence, we performed a meta-analysis to systematically review the impact of the presence or absence of CR on all-cause mortality in patients with LFLG AS who underwent TAVI.