Validation of Conventional and Simplified Methods to Calculate Projected Valve Area at Normal Flow Rate in Patients With Low Flow, Low Gradient Aortic Stenosis: The Multicenter TOPAS (True or Pseudo Severe Aortic Stenosis) Study

2010 ◽  
Vol 23 (4) ◽  
pp. 380-386 ◽  
Author(s):  
Marie-Annick Clavel ◽  
Ian G. Burwash ◽  
Gerald Mundigler ◽  
Jean G. Dumesnil ◽  
Helmut Baumgartner ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Flow Rate ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Normal Flow ◽  
Valve Area

scholarly journals Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis

Circulation ◽  
2006 ◽  
Vol 113 (5) ◽  
pp. 711-721 ◽  
Author(s):  
Claudia Blais ◽  
Ian G. Burwash ◽  
Gerald Mundigler ◽  
Jean G. Dumesnil ◽  
Nicole Loho ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Flow Rate ◽  
Low Flow ◽  
Normal Flow ◽  
Stenosis Severity ◽  
Valve Area

Abstract 12660: Impact of Aortic Valve Replacement versus Medical Management on Survival of Low Flow Low Gradient Severe Aortic Stenosis With Normal Ejection Fraction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Zaher Fanari ◽  
Dimitrios Barmpouletos ◽  
Vivek K Reddy ◽  
Sumaya Hammami ◽  
Zugui Zhang ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Rank Test ◽  
Normal Ejection Fraction ◽  
Normal Flow ◽  
Log Rank Test

Background: The impact of aortic valve replacement (AVR) versus medical management (MM) in patients with paradoxical low flow is unclear. The objective of this study was to compare outcomes of AVR versus MM in patients with severe aortic stenosis and normal ejection fraction and different transaortic flow and gradient. Methods: We identified consecutive patients presenting to our echo lab with an aortic valve area (AVA) < 1.0cm 2 and EF≥ 50%. We stratify patients depending on gradient (≥ 40 vs. < 40 mmHg) and stroke volume index (SVI < 35 vs. ≥35 ml/m 2 ). 4 groups were identified (, normal flow, high gradient [NF/HG]; normal flow, low gradient [NF/LG]; low flow, high gradient [LF/HG] and low flow, low gradient [LF/LG]. These 4 groups were also stratified depending on management (AVR vs. MM). All patients were retrospectively followed for the occurrence of death. Results: A total of 954 patients were included in analysis. Mean follow up was 2.45 ± 1.9 years. The mean age was 75.4 ± 5.6 years. Comparing all 4 AS subgroups, the mortality was higher in LF/HG followed by LF/LG, NF/HG and NF/LG (LF/HG 37.1% vs. LF/LG 33.9% vs. NF/HG 30.3%vs. NF/LG 20.2%; Log Rank Test, P=0.003). Patients who underwent medical therapy have a higher mortality than the overall cohort in all subgroups (LF/HG 44.3% vs. NF/HG 36.6% vs. LF/LG 33.7% vs. NF/LG 21.2%; Log Rank Test, P=0.001). Patients with HG had a higher chance of getting aortic valve replacement (AVR) than those with LF/LG and NF/LG (20.7% NF/HG vs. 10.6% LF/HG vs. 4.7% LF/LG and 3.6% NF/LG; P=0.01). Patients who underwent AVR had lower mortality rates when compared with the overall cohort in all subgroups (LF/HG 21.4% vs. 18.9% NF/HG vs. 6.6% LF/LG and 7.1% NF/LG; Log Rank Test, P= 0.253). Conclusion: Patients with LF/LG represent an under-recognized high-risk group with similar prognosis to NF/HG. Although these patients may benefit tremendously from AVR, they are less likely to undergo AVR when compared to HG patients.

scholarly journals Echocardiographic Evaluation of Aortic Stenosis – Normal Flow and Low Flow Scenarios

2014 ◽  
Vol 9 (2) ◽  
pp. 92
Author(s):  
Ian G Burwash ◽  
Keyword(s):  
Clinical Outcome ◽  
Aortic Stenosis ◽  
Patient Management ◽  
Low Flow ◽  
Normal Flow ◽  
Prognostic Information ◽  
Echocardiographic Evaluation ◽  
Mean Pressure ◽  
Echocardiographic Assessment ◽  
Valve Area

The echocardiographic evaluation of the patient with aortic stenosis (AS) has evolved in recent years, beyond confirming the diagnosis and measuring the resting mean pressure gradient or valve area. New echocardiographic approaches have developed to address the clinical dilemmas related to discordant haemodynamic data, asymptomatic haemodynamically severe AS and low-flow, low-gradient AS in order to better evaluate the disease severity, enhance the risk stratification of patients and provide important prognostic information. This article reviews the echocardiographic evaluation of the AS patient and focuses on the echocardiographic assessment of the haemodynamic severity, the prediction of clinical outcome and the use of echocardiography to guide patient management in the presence of normal flow and low flow scenarios.

scholarly journals Left ventricular mechanical dispersion in flow-gradient patterns of severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Lavall ◽  
L.K Kuprat ◽  
J Kandels ◽  
S Stoebe ◽  
A Hagendorff ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Mechanical Dispersion ◽  
Flow Gradient ◽  
Valve Area

Abstract Purpose Patients with severe aortic stenosis are classified according to flow-gradient patterns. We investigated whether left ventricular (LV) mechanical dispersion, a marker of dyssynchrony and predictor of mortality, is associated with low-flow status in aortic stenosis. Methods and results 400 consecutive patients with QRS duration &lt;120ms were included in the retrospective analysis. Patients with severe aortic stenosis (aortic valve area ≤1.0cm2) were classified as normal-flow (NF; stroke volume index &gt;35ml/m2) high-gradient (HG; mean transvalvular gradient ≥40mmHg) (n=79), NF low-gradient (LG) (n=62), low-flow (LF) LG ejection fraction (EF) ≥50% (n=57), and LF LG EF&lt;50% (n=23). Patients with moderate aortic stenosis (aortic valve area 1.5–1.0cm2; n=95) and patients with chronic systolic heart failure (n=84) without aortic stenosis served as comparison groups. Similar values of mechanical dispersion (calculated as standard deviation of time from Q/S onset on electrocardiogram to peak longitudinal strain in 17 left ventricular segments) was observed in patients with NF HG (49.4±14.7ms), NF LG (43.5±12.9ms), LF LG EF≥50% (47.2±16.3ms) and moderate aortic stenosis (44.2±15.7ms). Mechanical dispersion was increased in patients with LF LG EF&lt;50% (60.8±20.7ms) and in chronic heart failure (59.4±16.7ms) (p&lt;0.05 for both vs. NF HG‡, NF LG†, LF LG EF≥50%§ and moderate*; Figure). Mechanical dispersion correlated with LV end-systolic volume index (r=0.2530, p&lt;0.0001), LVEF (r=−0.2895, p&lt;0.0001) and global longitudinal strain (r=0.3108, p&lt;0.0001), but not with parameters of aortic stenosis. Conclusion Mechanical dispersion was similar among flow-gradient subgroups of severe aortic stenosis with preserved LVEF, but increased in patients with low-flow low-gradient and reduced LVEF. These findings indicate that mechanical dispersion is rather a marker of systolic myocardial dysfunction than of aortic stenosis. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 15001: Fusion of Echocardiographic Hemodynamic Data and Computed Tomographic Anatomical Data of the Aortic Valve Determine Severity of Low-Gradient Aortic Stenosis with Preserved Ejection Fraction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Vasileios Kamperidis ◽  
Philippe J van Rosendael ◽  
Spyridon Katsanos ◽  
Frank van der Kley ◽  
Madelien Regeer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Low Flow ◽  
Normal Flow ◽  
Area Index ◽  
High Gradient ◽  
Calcium Load

Introduction: Severe aortic stenosis with preserved left ventricular ejection fraction is classified into 4 groups, according to flow and gradient, with still debatable underlying pathophysiology. Hypothesis: The use of multi-detector computed tomography (MDCT) and Doppler echocardiography refines the differential characteristics and true severity of each aortic stenosis group. Methods: Patients with severe aortic stenosis [aortic valve area index (AVAi) <0.6cm2/m2] and ejection fraction ≥50% (n=191, age 80±7 years, 48.2% male) with echocardiography and MDCT prior to transcatheter aortic valve replacement were included. Patients were classified into 4 groups based on stroke volume index (≤35 or >35 ml/m2) and mean pressure gradient (≤40 or >40mmHg): 1. Normal-flow, high-gradient, 2. Low-flow, high-gradient, 3. Normal-flow, low-gradient, 4. Low-flow, low-gradient. Aortic valve calcium was evaluated on MDCT. Fusion AVAi was estimated by continuity equation using Doppler hemodynamics and MDCT left ventricular outflow tract (LVOT) area. Results: AVAi and LVOT area index were both significantly different among the 4 groups when evaluated by echocardiography. On MDCT, although LVOT area index was comparable among groups, fusion AVAi remained significantly different (Figure): normal-flow, low-gradient had the largest area (0.62±0.11cm2/m2), resulting in reclassification into moderate stenosis in 52% of these patients, while low-flow, low-gradient group had comparable fusion AVAi to normal-flow, high-gradient group. Aortic valve calcium load was largest among patients with high-gradient (median 3412AU for normal-flow and 3181AU for low-flow) and was comparable between patients with low-gradient (2143AU for normal-flow and 2310AU for low-flow). Conclusion: MDCT refines the hemodynamic characterization of low gradient AS patients by providing more accurate AVAi estimation and calcium load.

Clinical features and prognosis of patients with isolated severe aortic stenosis and valve area less than 1.0 cm2

Heart ◽  
2017 ◽  
Vol 104 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Praveen Mehrotra ◽  
Katrijn Jansen ◽  
Timothy C Tan ◽  
Aidan Flynn ◽  
Judy W Hung
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Features ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Aortic Valve Area ◽  
High Gradients ◽  
Current Guidelines ◽  
Valve Area

ObjectiveCurrent guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)≤1.0 cm2, but some authors have suggested that the AVA cut-off be decreased to 0.8 cm2. The aim of this study was, therefore, to better describe the clinical features and prognosis of patients with an AVA of 0.8–0.99 cm2.MethodsPatients with isolated, severe AS and ejection fraction ≥55% with an AVA of 0.8–0.99 cm2 (n=105) were compared with those with an AVA<0.8 cm2 (n=155) and 1.0–1.3 cm2 (n=81). The endpoint of this study was a combination of death from any cause or aortic valve replacement at or before 3 years.ResultsPatients with an AVA of 0.8–0.99 cm2 group comprised predominantly normal-flow, low-gradient (NFLG) AS, while high gradients and low flow were more often observed with an AVA<0.8 cm2. The frequency of symptoms was not significantly different between an AVA of 0.8–0.99 cm2 and 1.0–1.3 cm2. The combined endpoint was achieved in 71%, 52% and 21% of patients with an AVA of 0.8 cm2, 0.8–0.99 cm2and 1.0–1.3 cm2, respectively (p<0.001). Among patients with an AVA of 0.8–0.99 cm2, NFLG AS was associated with a lower hazard (HR=0.40, 95% CI 0.23 to 0.68, p=0.001) of achieving the combined endpoint with outcomes similar to moderate AS in the first 1.5 years of follow-up. Patients with high-gradient or low-flow AS with an AVA of 0.8–0.99 cm2 had outcomes similar to those with an AVA<0.8 cm2. The sensitivity for the combined endpoint was 61% for an AVA cut-off of 0.8 cm2 and 91% for a cut-off of 1.0 cm2.ConclusionsThe outcomes of patients with AS with an AVA of 0.8–0.99 cm2 are variable and are more precisely defined by flow-gradient status. Our findings support the current AVA cut-off of 1.0 cm2.

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