Fração de ejeção baixa com estenose... Parte 3

Outcome of Patients With Low-Gradient "Severe" Aortic Stenosis and Preserved Ejection Fraction
Methods and Results— Outcome in patients with low-gradient "severe" aortic stenosis was compared with outcome in patients with moderate stenosis (aortic valve area 1.0 to 1.5 cm2; mean gradient 25 to 40 mm Hg). The primary end point of aortic valve events included death from cardiovascular causes, aortic valve replacement, and heart failure due to aortic stenosis. Secondary end points were major cardiovascular events and cardiovascular death. In 1525 asymptomatic patients (mean age, 67±10 years; ejection fraction, 55%), baseline echocardiography revealed low-gradient severe stenosis in 435 patients (29%) and moderate stenosis in 184 (12%). Left ventricular mass was lower in patients with low-gradient severe stenosis than in those with moderate stenosis (182±64 versus 212±68 g; P<0.01). During 46 months of follow-up, aortic valve events occurred in 48.5% versus 44.6%, respectively (P=0.37; major cardiovascular events, 50.9% versus 48.5%, P=0.58; cardiovascular death, 7.8% versus 4.9%, P=0.19). Low-gradient severe stenosis patients with reduced stroke volume index (35 mL/m2; n=223) had aortic valve events comparable to those in patients with normal stroke volume index (46.2% versus 50.9%; P=0.53). . Conclusions— Patients with low-gradient "severe" aortic stenosis and normal ejection fraction have an outcome similar to that in patients with moderate stenosis........................................................................................................ . . . . Opa, espere um pouco.
Não era alegado que a fração de ejeção baixa com gradiente baixo tinha prognóstico ruim e nem deveria ser operado????
Pra variar, colocam pacientes diferentes no mesmo grupo e cada estudo dá uma diretriz diferente!
Moral da história:
Antes de recusar a cirurgia para seu paciente, estude-o melhor.
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Circulation. 2011;123:887-895