Clinical outcome and functional characteristics of patients with asymptomatic low-flow low-gradient severe aortic stenosis with preserved ejection fraction are closer to high-gradient severe than to moderate aortic stenosis

2017 ◽  
Vol 34 (4) ◽  
pp. 545-552 ◽  
Author(s):  
Mohammad Kavianipour ◽  
Amir Farkhooy ◽  
Frank A. Flachskampf
Keyword(s):  
Clinical Outcome ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Preserved Ejection Fraction ◽  
Functional Characteristics ◽  
High Gradient

scholarly journals 620 Normalized stroke volume in severe aortic stenosis with preserved ejection fraction: reference values and outcome implications

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Y Bohbot ◽  
D Rusinaru ◽  
E Rietzschel ◽  
M De Buyzere ◽  
O Buicuic ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Reference Values ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Preserved Ejection Fraction ◽  
Prognostic Performance ◽  
Risk Of Death ◽  
Normalization Methods

Abstract Funding Acknowledgements none Background Appropriate normalization methods to scale Doppler-derived stroke volume (SV) in patients with aortic stenosis (AS) are poorly defined and reference values are lacking. Purpose We aim to establish reference values for normalized SV, to compare the prognostic value of SV normalized by different methods in AS and to examine the outcome of low-flow(LF) low-gradient(LG) AS with preserved ejection fraction(LVEF) based on newly defined reference values. Methods In 2781 normotensive adults without cardiovascular disease we defined normal relationships between SV and body size by nonlinear regression. We analyzed the prognostic performance of ratiometric and allometric normalized SV in 1450 patients with severe AS and preserved LVEF. Results The allometric exponents that described the SV-height (H) and SV-body surface area (BSA) relationships were 1.32 and 0.88, respectively. In males, LF reference values were: <28ml/m²,<30ml/m,<30ml/(m²)^0.88, and, respectively,<26 ml/m^1.32, and in females <27ml/m²,<28ml/m,<29ml/(m²)^0.88, and, respectively,<24 ml/m^1.32. In patients with severe AS, SV/H^1.32 was most consistently associated with mortality and showed better prognostic performance than other normalized SV parameters. Compared to H-normalization, BSA-normalization markedly overestimated the frequency of LF (2% vs. 11%). In 1354 AS patients managed initially medically, LF/LG AS defined based on the 35ml/m² cut-off showed better outcome than high gradient(HG) AS (adjusted HR 0.85[0.62-0.96]). When new reference values were used, the mortality risk of LF/LG AS was higher than that of HGAS (adjusted HR 1.37[1.06-1.89] for SV/BSA and adjusted HR 1.42[1.10-2.15] for SV/H^1.32). Conclusion We provide reference values and appropriate normalization methods for SV by Doppler-echocardiography. Patients with LG severe AS, preserved LVEF and "true" LF are at high risk of death during follow-up. Abstract 620 Figure. Frequency of flow-gradient patterns

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.

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