P973Low pulse pressure in aortic stenosis indicates poor left ventricular function but not severe aortic stenosis

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Introduction: Attenuation of pulse pressure (PP) is taught as a marker of aortic stenosis (AS) severity. However, clinical data to demonstrate this in a large group of patients have never been presented. We examined whether non-invasive PP is indeed an index of severity of AS.Method: Echocardiographic records from our institute were retrospectively examined from 2004 to 2010 and all patients with an aortic valve area (AVA) <1.0cm2 identified. Exclusion criteria included significant aortic regurgitation, previous aortic valve intervention and other significant valvular abnormalities. Documented blood pressures were obtained from within 6 months of the echo date and compared with AVA, aortic Peak Velocity (PV) and VTI, and Ejection Fraction (calculated using the biplane Simpson's method). Mortality status was obtained from general practitioner records.Results: Of the 328 eligible patients, mean age was 76.6±11.5 years and 95% had degenerative tri-leaflet AS. Mean PP was 61±18.8 mmHg. PP was not correlated with AVA (r=0.01, p=0.86), PV (r=0.04, p=0.48) or aortic valve VTI (r=0.02, p=0.72). PP was significantly correlated with ejection fraction (r=0.14, p=0.016). Mortality from date of echo to December 2010 was not associated with PP but was associated with LV function.Discussion: We have demonstrated that, contrary to the classical teaching, pulse pressure is not directly associated with the severity of aortic stenosis but does reflect LV dysfunction in these patients. There are many possible explanations including the ability of an unimpaired LV to overcome valvular obstruction. We should revise our teaching: normal or wide PP is of little use excluding a diagnosis of severe AS. A narrow PP is more a marker of LV impairment than of aortic stenosis itself.

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