scholarly journals Assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Strangio ◽  
J Sabatino ◽  
I Leo ◽  
M Maglione ◽  
F Troilo ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Left Ventricular ◽  
Flow Dynamics ◽  
Vortical Flow ◽  
Paravalvular Leak ◽  
Vortex Center ◽  
Aortic Valve Area ◽  
Longitudinal Length ◽  
Significant Difference ◽  
Intracardiac Flow

Abstract Background Assessment of intracardiac flows and turbulence has acquired rising significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have shown that alterations in intracardiac fluid dynamics can be helpful to identify abnormalities in cardiac function. Purpose This study investigates the additional information provided by the quantitative assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods Sixty-one patients with severe AS (33 females) and 38 healthy sex- and BSA-matched controls (CTRL) (15 females) were prospectively included and underwent echocardiographic assessment of intracardiac flow dynamics. Echocardiographic measurements were performed on apical three chamber views. The HyperDoppler software adapted to the echo-scanner without contrast injection was used to assess intracardiac vortex properties. The following parameters were obtained: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Inter-rater variability was measured using intraclass correlation coefficients (ICCs) between two independent operators. Results Patients with severe AS (mean gradient: 47,5±13,9 mmHg; aortic valve area: 0.7±0.2 cm2; ejection fraction: 53±7%) had increased LV wall thickness (p<0.001) and mass index (p<0.001) compared with controls. Greater indexed left atrial volume (p<0.001), E/e' (p<0.001) and trans-tricuspid gradient (p<0.001) were also observed in the AS group. The assessment of VA, VL and VD was feasible in the whole population. Their calculation was reliable, as ICCs were very good for VA (0.878, p=0.033), VL (0.960, p=0.004) and VD (0,905, p=0.021). Mean VA was significantly larger in patients with severe aortic stenosis compared with CTRL (p=0.033). VL and VD (p=0.026 and p>0.001, respectively) were significantly higher in AS patients compared with CTRL. Among those who underwent TAVR, we observed a significant difference in the delta values of VA and VL pre-postTAVR in patients with and without significant paravalvular leak (p<0.05). Conclusions The newly defined VA, VL and VD, quantitative indices of vortical flow, were significantly increased in the LV cavity of patients with severe AS compared to normal subjects. These indices, whose measurement was feasible and reliable, might provide complementary information to standard echocardiography, useful for the further diagnostic and prognostic characterization of the heterogeneous population of patients with severe AS. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals 746 Assessment of intracardiac fluid-dynamics of patients with aortic stenosis

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Jolanda Sabatino ◽  
Isabella Leo ◽  
Antonio Strangio ◽  
Sabrina La Bella ◽  
Marco Maglione ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Aortic Stenosis ◽  
Clinical Setting ◽  
Flow Dynamics ◽  
Paravalvular Leak ◽  
Quantitative Indices ◽  
Significant Difference ◽  
Technological Developments ◽  
Intracardiac Flow ◽  
Echocardiographic Assessment

Abstract Aims Recent technological developments enabled visualization of intracardiac flow patterns. This study aims to evaluate intracardiac flow dynamics of patients with aortic stenosis (AS). Methods and results Sixty-one patients with severe AS and 38 healthy sex- and BSA-matched controls (CTRL) were prospectively included. Standard echocardiographic assessment was performed in all patients. Fluid dynamics were evaluated using the HyperDoppler software to measure vortex area (VA), vortex length (VL), and vortex depth (VD). The assessment of VA, VL, and VD was feasible and reliable, as the inter-rater variability (ICCs) were very good for VA (0.878, P = 0.033), VL (0.960, P = 0.004), and VD (0.905, P = 0.021). Mean VA, VL, and VD (P = 0.033, P = 0.026, and P > 0.001, respectively) were significantly larger in AS patients compared with CTRL. A significant difference in the delta values of VA and VL, reflecting their change from before to after TAVI, was observed in patients with and without significant paravalvular leak. Conclusions The newly developed quantitative indices of flow dynamics, namely VA, VL, and VD, were significantly increased in the LV of patients with severe AS compared to controls and their measurement was feasible and reliable in a clinical setting.

scholarly journals Assessment of intracardiac flow dynamics for the evaluation of patients with different ventricular geometry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Leo ◽  
J Sabatino ◽  
A Strangio ◽  
M Maglione ◽  
F Troilo ◽  
...  
Keyword(s):  
Dynamic Analysis ◽  
Fluid Dynamic ◽  
Statistical Significance ◽  
Left Ventricular ◽  
Frame Rate ◽  
Vortex Center ◽  
Ventricular Geometry ◽  
Longitudinal Length ◽  
Echocardiographic Examination ◽  
Intracardiac Flow

Abstract Background Over the last decades growing evidence have demonstrated the promising role of intracardiac flow dynamic analysis in evaluating cardiac performance. Diastolic forces contribute to the formation of vortices, complex structures capable of kinetic energy storage and responsible of a smoother transition of blood from left ventricular (LV) inlet to outlet. Change in shape and location of these structures has been related with cardiovascular disease and prognosis. Purpose To investigate quantitative changes in vortices parameters in patients with different ventricular geometry. Methods We enrolled 72 consecutive patients (age 66±11 years, 49 male, 68%) with LV concentric hypertrophy (CH, n=15), eccentric hypertrophy (EH, n=13), concentric remodeling (CR, n=15) and normal LV geometry (CTRL, n=29). Each patient underwent a complete echocardiographic examination and a non-invasive intracardiac fluid dynamic analysis by Color Vector Flow Mapping. A 3-chamber apical view with a frame rate between 22 and 25 Hz has been acquired and subsequently analyzed offline by a semi-automatic software obtaining the following parameters: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Bland Altman Plot has been used to assess intra and inter-observer variability. Results Mean VD was higher in CR, CH and EH compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). Moreover, CH showed higher VL (p=0.006) and larger VA (p=0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (p=0.21 and p=0.07 for VA and VL respectively). No significative differences in vortices parameters have been observed between CH and EH. Conclusion(s) This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Higher values of VD were found in CR, CH and EG. Quantitative intra dynamic fluid assessment was feasible and reliable in the whole population and could provide additional information to the standard echocardiographic examination. FUNDunding Acknowledgement Type of funding sources: None.

Left atrial dynamics in the hemodynamic response during exercise in patients with asymptomatic severe aortic stenosis: a cardiopulmonary imaging study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Sugimoto ◽  
F Bandera ◽  
M Barletta ◽  
E Alfonzetti ◽  
M Guazzi
Keyword(s):  
Aortic Stenosis ◽  
Left Atrial ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Pressure ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Significant Difference

Abstract Background The hemodynamic impact of left atrial (LA) dynamics in aortic stenosis (AS) in relation to cardiopulmonary response to exercise has never been studied. We aimed at investigating the link between LA function vs valvulo-arterial impedance (Zva) and right ventricular (RV)-to-pulmonary circulation (PC) coupling in asymptomatic severe AS patients. Methods A total of 94 patients: 64 asymptomatic severe AS patients (aortic valve area (AVA) <1.0 cm2 or AVA index <0.6 cm2/m2) with ejection fraction >50% and 30 gender-matched control subjects underwent cardiopulmonary exercise testing combined with Echo-Doppler with assessment of LA strain and RV-to-PC coupling (tricuspid annular peak systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio). AS patients were divided into 3 groups according to peak aortic jet velocity (PV), mean pressure gradient (MPG) and stroke volume index (SVI). Zva was assessed using (MPG + systolic blood pressure)/ SVI ratio. Results Paradoxical low-flow low-gradient AS (PLFLG: PV <4 m/s and MPG <40 mmHg, SVI ≤35ml/m2, N=18, AVA 0.77±0.16 cm2), Normal-flow low-gradient AS (NFLG: PV <4 m/s and MPG <40 mmHg, SVI >35ml/m2, N=23, AVA 0.85±0.16 cm2) and High-gradient AS (HG: PV ≥4 m/s or MPG ≥40 mmHg, N=20, AVA 0.62±0.17 cm2) had a higher LA volume index than Control (Control 22±6, PLFLG 33±11*, NFLG 38±12* and HG 33±9* ml/m2, *P<0.05 vs Control). There was no significant difference in peak VO2 (17±5 ml/min/kg) and VE/VCO2 slope (28±3) among 3 AS groups although PLFLG had lower peak cardiac output (7.0±2.4 L/min) compared to NFLG (9.0±2.3 L/min) and HG (9.2±3.3 L/min). In PLFLG and NFLG AS, LA strain at rest (21±9 and 26±13%) and during exercise (26±12 and 31±14%) were decreased compared to Control (37±8% at rest, 43±11% during exercise) but maintained some reserve during exercise (P<0.001). HG AS had no increase in LA strain (31±15% at rest, 28±15% during exercise) (Figure A). In AS groups, no significant correlation at rest was observed between LA strain and Zva, whereas a negative correlation was observed during exercise (R=−0.4, P=0.003, Figure B). LA strain was also correlated with TAPSE/PASP at rest and exercise (R=0.44 and 0.47, P<0.01, respectively, Figure C). Conclusions In asymptomatic severe AS, the study of LA functional adaptation to exercise plays a key role in the hemodynamic unfavorable cascade from AS-related left ventricular afterload to RV-to-PC uncoupling. Funding Acknowledgement Type of funding source: None

scholarly journals P907 Ventriculo-vascular interaction in patients with severe aortic stenosis: a comparison of three different clinical settings

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A E Vijiiac ◽  
C Neagu ◽  
A Cherry ◽  
S Onciul ◽  
D Zamfir ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Arterial System ◽  
Left Ventricular Ejection ◽  
Clinical Settings ◽  
Aortic Valve Area ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF Ventriculo-arterial coupling (VAC) reflects the interaction between the ventricle and the arterial system and its prognostic role was studied in different clinical settings. VAC can be assessed with echocardiography as the ratio between the arterial elastance (Ea) and the end-systolic left ventricular elastance (EES). Data concerning the role of VAC in severe aortic stenosis (AS) are scarce. We aimed to determine VAC in patients (pts) with severe AS and assess its relationship with symptoms. We included 61 consecutive pts with severe AS (vave area < 1 cm2) and we divided them in 3 groups according to their symptoms: group A consisted of 28 pts (81 ± 10 yrs, 14 men) admitted for acute pulmonary edema, group B consisted of 25 pts (76 ± 12 yrs, 13 men) with either angina, syncope or dyspnea class I-III NYHA and group C consisted of 8 asymptomatic patients (71 ± 19 yrs, 3 men). We determined the VAC non-invasively and we compared the results between the 3 groups using one-way analysis of variance and a post-hoc Tukey test. There were no significant differences in age (p = 0.08) and aortic valve area (p = 0.18) between groups. Variations of Ea and EES between groups were not significant (p = 0.08 and p = 0.94, respectively). However, VAC differed significantly between the 3 groups, being most impaired in group A (1.11 ± 0.69), followed by 0.77 ± 0.23 in group B and 0.73 ± 0.16 in group C (p = 0.03). The left ventricular ejection fraction (EF) also differed significantly between groups: 41 ± 13% in group A, 51 ± 11% in group B and 57 ± 3% in group C (p < 0.001). VAC and the EF had a moderate negative correlation in group A (r=-0.52, p = 0.004) and group B (r=-0.51, p = 0.009), but no correlation in group C (p = 0.37). VAC is impaired in patients with severe AS and acute heart failure and it differs significantly from VAC in severe AS with chronic, stable symptoms and from VAC in asymptomatic severe AS. This suggests that the progression of symptoms in severe AS might be related to the interactions between the left ventricle and the vascular load, making thus VAC a potential therapeutic target and a parameter to be considered in the thorough evaluation of patients with severe AS. Group A Group B Group C Ea 2.69 ± 1.31 2.09 ± 0.94 1.95 ± 0.60 p = 0.08 EES 2.93 ± 1.90 2.87 ± 1.33 2.71 ± 0.73 p = 0.94 VAC 1.11 ± 0.69 0.77 ± 0.23* 0.73 ± 0.16* p = 0.03 EF 41 ± 13% 51 ± 11%* 57 ± 3%* p < 0.001 *significant difference with group A

Echocardiographic findings on aortic stenosis: an observational, prospective, and multi-center registry

Perfusion ◽  
2020 ◽  
pp. 026765912092492
Author(s):  
Shehab Anwer ◽  
Didem Oğuz ◽  
Laura Galian-Gay ◽  
Irena Peovska Mitevska ◽  
Lilit Baghdassarian ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Right Ventricular ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Significant Difference

Background: The aim of this aortic stenosis registry was to investigate the changes of routine echocardiographic indices and strain in patients with moderate-to-severe aortic stenosis over a 6-month follow-up period. Methods: Our aortic stenosis registry is observational, prospective, multicenter registry of nine countries, with 197 patients with aortic valve area less than 1.5 cm2. The enrolment took place from January to August 2017. We excluded patients with uncontrolled atrial arrhythmias, pulmonary hypertension or cardiomyopathies, as well as those with hemodynamically significant valvular disease other than aortic stenosis. We included patients who did not require intervention and who had a complete follow-up study. Results: In patients with preserved ejection fraction, left ventricular mass has significantly increased between baseline and follow-up studies (218 ± 34 grams vs 253 ± 29 grams, p = 0.02). However, when indexed to body surface area, there was no significant difference. Left ventricular global longitudinal strain significantly decreased (-19.7 ± -4.8 vs (-16.4 vs -3.8, p = 0.01). Left atrial volume was significantly higher at follow-up (p = 0.035). Right ventricular basal diameter and mid-cavity diameter were greater at the follow-up (p = 0.04 and p = 0.035, respectively). Patients with low-flow low-gradient aortic stenosis had significantly lower global longitudinal strain (-12.3% ± -3.9% vs -19.7% ± -4.8%, p = 0.01). Conclusion: Left atrial dilatation is one of the first changes to take place in low-flow low-gradient aortic stenosis patients even when left ventricular dimensions and function remains intact. Global longitudinal strain is an important determinant of left ventricular systolic and diastolic dysfunction and right ventricular function is an important parameter of aortic stenosis assessment. Accordingly, our registry has further shed the light on these indices role as multisite follow-up of aortic stenosis.

Abstract 15267: 1-Year Survival Post Trans-Catheter Aortic Replacement in Patients With Low and High-gradient Severe Aortic Valve Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Caleb Chiang ◽  
Mohamad Hemu ◽  
Jaafar Alward ◽  
Konstantinos Voudris ◽  
Hassam Suradi
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
High Gradient ◽  
Aortic Replacement ◽  
Significant Difference

Introduction: There is limited data on trans-catheter aortic replacement (TAVR) outcomes in patients with low gradient-preserved ejection fraction aortic stenosis (LGpEF). Our study aims to compare baseline characteristics and procedural outcomes in patients with LGpEF vs. high gradient severe aortic stenosis (HGAS). Methods: Patients who underwent TAVR at our institution were divided in 2 groups: 1) HGAS (aortic valve area (AVA) < 1cm 2 , mean gradient (MG) > 40 mmHg); 2) LGpEF (AVA < 1cm 2 , MG <40 mmHg, left ventricular ejection fraction ≥ 50%). Primary outcome included 1-year all-cause mortality post-TAVR. Multivariable cox proportional hazards model was adjusted for covariates of clinical significance (age, Society of Thoracic Surgery (STS) score, chronic kidney disease (GFR < 60 mL/min/1.73m2), para-valvular leak (PVL) day 1 post-TAVR, and baseline New York Heart Association (NYHA) class. Results: A total of 140 patients with HGAS (53% female, 81±9 years old) and 73 patients with LGAS (51% female, 80±9.5 years old) were identified. In multivariable analyses, there was no statistically significant difference in mortality between HGAS vs. LGpEF (HR 0.53, 95% CI 0.21-1.3; p=0.16) (Figure). PVL was independently associated with increased mortality in HGAS (HR 2.9, 95% CI 1.2-7.3; p=0.02) but this effect was not observed in patients with LGpEF. Conclusions: After adjusting for relevant patient characteristics, TAVR outcomes in patients with LGpEF were similar to those with HGAS at 1-year follow-up.

scholarly journals Natural Progression of Low-Gradient Severe Aortic Stenosis with Preserved Ejection Fraction

2014 ◽  
Vol 41 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Antony Leslie Innasimuthu ◽  
Sanjay Kumar ◽  
Jason Lazar ◽  
William E. Katz
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Mild Stenosis ◽  
Natural Progression

Because the natural progression of low-gradient aortic stenosis (LGAS) has not been well defined, we performed a retrospective study of 116 consecutive patients with aortic stenosis who had undergone follow-up echocardiography at a median interval of 698 days (range, 371–1,020 d). All patients had preserved left ventricular ejection fraction (&gt;0.50) during and after follow-up. At baseline, patients were classified by aortic valve area (AVA) as having mild stenosis (≥1.5 cm2), moderate stenosis (≥1 to &lt;1.5 cm2), or severe stenosis (&lt;1 cm2). Severe aortic stenosis was further classified by mean gradient (LGAS, mean &lt;40 mmHg; high-gradient aortic stenosis [HGAS], mean ≥40 mmHg). We compared baseline and follow-up values among 4 groups: patients with mild stenosis, moderate stenosis, LGAS, and HGAS. At baseline, 30 patients had mild stenosis, 54 had moderate stenosis, 24 had LGAS, and 8 had HGAS. Compared with the moderate group, the LGAS group had lower AVA but similar mean gradient. Yet the actuarial curves for progressing to HGAS were significantly different: 25% of patients in LGAS reached HGAS status significantly earlier than did 25% of patients in the moderate-AS group (713 vs 881 d; P=0.035). Because LGAS has a high propensity to progress to HGAS, we propose that low-gradient aortic stenosis patients be closely monitored as a distinct subgroup that warrants more frequent echocardiographic follow-up.

scholarly journals Aortic valve area, stroke volume,left ventricular hypertrophy, remodeling and fibrosis in aortic stenosis assessed by cardiac MRI

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P277-P277
Author(s):  
G. Barone-Rochette ◽  
S. Pierard ◽  
S. Seldrum ◽  
C. De Meester De Ravensteen ◽  
J. Melchior ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Stroke Volume ◽  
Cardiac Mri ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Valve Area

High Prevalence of Severe Aortic Stenosis in Low-Flow State Associated With Atrial Fibrillation

2021 ◽  
Author(s):  
Said Alsidawi ◽  
Sana Khan ◽  
Sorin V. Pislaru ◽  
Jeremy J. Thaden ◽  
Edward A. El-Am ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Flow State ◽  
Ventricular Ejection Fraction

Background: Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity ≥4 m/s or mean gradient ≥40 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS). Methods: One thousand five hundred forty-one patients with aortic valve area ≤1 cm 2 and left ventricular ejection fraction ≥50% were identified and classified as high-gradient AS (HGAS) (≥40 mm Hg) and LGAS (<40 mm Hg), and AF versus sinus rhythm (SR). Available computed tomography aortic valve calcium scores (AVCS) were retrieved from the medical record. Outcomes were assessed. Results: Mean age was 76±11 years, female 47%. Mean gradient was 51±12 in SR-HGAS, 48±10 in AF-HGAS, 31±5 in SR-LGAS, and 29±7 mm Hg in AF-LGAS, all P ≤0.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581–3462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978–4229, P =0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817–2810, P =0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945–1832, P <0.001); AVCS in AF-LGAS were higher when HS were present ( P =0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40–2.36], P <0.001) and AF-LGAS with HS (hazard ratio=1.54 [1.04–2.26], P =0.03) but not different in AF-LGAS without HS or SR-LGAS (both P =not significant). Conclusions: Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.

scholarly journals Impact of left ventricular outflow tract flow acceleration on aortic valve area calculation in patients with aortic stenosis

2019 ◽  
Vol 6 (4) ◽  
pp. 97-103 ◽  
Author(s):  
Andaleeb A Ahmed ◽  
Robina Matyal ◽  
Feroze Mahmood ◽  
Ruby Feng ◽  
Graham B Berry ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Continuity Equation ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Area Measurement ◽  
Aortic Valve Area ◽  
Flow Acceleration ◽  
The Impact ◽  
Valve Area

Objective Due to its circular shape, the area of the proximal left ventricular tract (PLVOT) adjacent to aortic valve can be derived from a single linear diameter. This is also the location of flow acceleration (FA) during systole, and pulse wave Doppler (PWD) sample volume in the PLVOT can lead to overestimation of velocity (V1) and the aortic valve area (AVA). Therefore, it is recommended to derive V1 from a region of laminar flow in the elliptical shaped distal LVOT (away from the annulus). Besides being inconsistent with the assumptions of continuity equation (CE), spatial difference in the location of flow and area measurement can result in inaccurate AVA calculation. We evaluated the impact of FA in the PLVOT on the accuracy of AVA by continuity equation (CE) in patients with aortic stenosis (AS). Methods CE-based AVA calculations were performed in patients with AS once with PWD-derived velocity time integral (VTI) in the distal LVOT (VTILVOT) and then in the PLVOT to obtain a FA velocity profile (FA-VTILVOT) for each patient. A paired sample t-test (P < 0.05) was conducted to compare the impact of FA-VTILVOT and VTILVOT on the calculation of AVA. Result There were 46 patients in the study. There was a 30.3% increase in the peak FA-VTILVOT as compared to the peak VTILVOT and AVA obtained by FA-VTILVOT was 29.1% higher than obtained by VTILVOT. Conclusion Accuracy of AVA can be significantly impacted by FA in the PLVOT. LVOT area should be measured with 3D imaging in the distal LVOT.

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