scholarly journals Differential left ventricular remodelling and longitudinal function distinguishes low flow from normal-flow preserved ejection fraction low-gradient severe aortic stenosis

2013 ◽  
Vol 34 (25) ◽  
pp. 1906-1914 ◽  
Author(s):  
P. Mehrotra ◽  
K. Jansen ◽  
A. W. Flynn ◽  
T. C. Tan ◽  
S. Elmariah ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Low Flow ◽  
Preserved Ejection Fraction ◽  
Normal Flow ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
Longitudinal Function

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.

P3366Increased left ventricular remodelling index in paradoxical low-flow severe aortic stenosis with preserved left ventricular ejection fraction compared to normal-flow

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Ngiam ◽  
N Chew ◽  
H W Sim ◽  
Y Q B Tan ◽  
C H Sia ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Normal Flow ◽  
Ventricular Remodelling ◽  
Left Ventricular Remodelling ◽  
Ventricular Ejection Fraction

Abstract Background Left Ventricular Remodelling Index (LVRI) has been demonstrated to be able to reliably discriminate between an athlete's heart and pathological LV remodelling. Patients with paradoxical low-flow severe aortic stenosis (LF AS) despite preserved left ventricular ejection fraction (LVEF) are a distinct group from normal-flow (NF) with poorer prognosis, more concentric hypertrophy and smaller LV cavities. Purpose We compared LVRI in LF compared to NF AS and examined clinical outcomes. Methods We studied consecutive patients with index echocardiographic diagnosis of severe AS (aortic valve area<1cm2) with preserved LVEF (>50%). LVRI was determined by the ratio of LV mass to the end-diastolic volume. Results Of the 450 patients studied, 149 (33.1%) were LF. There were no significant differences in baseline clinical profile of patients between LF and NF. LVRI was significantly higher in patients with LF compared to NF (2.27±0.68 vs 1.85±0.53 g/ml, p<0.001). Patients with high LVRI (>1.56 g/ml) had poorer clinical outcomes in terms of mortality (log-rank 9.18, p=0.002) and admissions for cardiac failure (log-rank 7.61, p=0.006). Low-flow (n=149) Normal-flow (n=301) Mean difference/Odds Ratio (95% CI) p-value Age (years) 73.5 (±12.8) 71.0 (±13.1) 2.5 (−0.1 to 5.1) 0.053 Body Mass Index (g/m2) 24.6 (±5.6) 24.7 (±5.3) −0.1 (−1.2 to 1.1) 0.877 Gender (male) 49 (32.9%) 125 (41.5%) 0.7 (0.5 to 1.1) 0.076 Hypertension 100 (67.1%) 195 (64.8%) 1.1 (0.7 to 1.7) 0.624 Diabetes 57 (38.3%) 100 (33.2%) 1.2 (0.8 to 1.9) 0.295 Hyperlipidaemia 79 (53.0%) 147 (49.0%) 1.2 (0.8 to 1.7) 0.425 End-diastolic volume (ml) 72.3 (±18.9) 112.6 (±26.3) −40.2 (−44.9 to −35.5) <0.001 Left ventricular ejection fraction (%) 66.0 (±7.9) 67.4 (±7.1) −1.4 (−2.9 to 0.2) 0.077 Left ventricular mass index (g/m2) 99.7 (±33.0) 126.8 (±37.4) −27.2 (−34.8 to −19.6) <0.001 Transaortic mean pressure gradient (mmHg) 32.2 (±17.4) 37.1 (±19.9) −4.9 (−8.6 to −1.1) 0.011 Aortic valve area (cm2) 0.78 (±0.16) 0.79 (±0.17) 0.1 (−0.2 to 0.1) 0.635 Stroke volume index (ml/m2) 28.6 (±5.6) 46.9 (±9.8) −18.3 (−20.0 to −16.6) <0.001 Left ventricular remodelling index (LVRI, g/ml) 2.27 (±0.68) 1.85 (±0.53) 0.42 (0.31 to 0.54) <0.001 LVRI in LF versus NF AS Conclusion Pathological LV remodelling as evidenced by increased LVRI was more common in LF compared to NF AS. Patients with increased LVRI also had worse clinical outcomes. Acknowledgement/Funding None

scholarly journals Comparing characteristics and clinical and echocardiographic outcomes in low-flow vs normal-flow severe aortic stenosis with preserved ejection fraction in an Asian population

2017 ◽  
Vol 34 (5) ◽  
pp. 638-648 ◽  
Author(s):  
Jinghao Nicholas Ngiam ◽  
Benjamin Yong-Qiang Tan ◽  
Ching-Hui Sia ◽  
Glenn K.M. Lee ◽  
William K.F. Kong ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Asian Population ◽  
Low Flow ◽  
Preserved Ejection Fraction ◽  
Normal Flow
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