Valve area and the risk of overestimating aortic stenosis

ObjectiveTo obtain reference values of aortic valve area (AVA) in a large population and to infer the risk of overestimating aortic stenosis (AS) when focusing on flow-corrected indices of severity.MethodsWe prospectively measured indices of AS in all consecutive echocardiograms performed in a large referral cardiac imaging laboratory for 1 year. We specifically analysed the distribution of AVA, indexed AVA and velocity ratio (Vratio) in patients with and without AS, the latter defined as the coexistence of valvular outflow obstruction (Vmax ≥2.5 m/s) and morphological findings of valve degeneration.Results16 156 echocardiograms were analysed, 14 669 of which did not show valvular obstruction (peak jet velocity <2.5 m/s). In the latter group, AVA was 2.6±0.7 cm2 in 8190 studies with normal valves and 2.3±0.7 cm2 in 6479 studies with aortic sclerosis (AScl). There was a relatively wide overlap between values of AVA, indexed AVA and velocity ratio between studies of patients with AScl and AS. Values of AVA ≤1.0 cm2 were found in 0.5% of studies with normal valves and 1.8% of studies with AScl. These proportions were 3.1% and 9.3% for AVA ≤1.5 cm2, respectively. Vratio ≤0.25 were found in 0.1% of patients without obstruction. Risk factors for a small AVA in patients without obstruction were AScl, female sex, small body surface area, low ejection fraction and mitral regurgitation.ConclusionsNormal values of continuity-equation derived AVA are smaller than previously considered. AVA values below cutoffs of moderate or severe AS can be found in patients without the disease. Flow-corrected indices may overestimate AS in patients with low gradients, particularly in the presence of well-identified risk factors.

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Abstract 4290: Risk Factors and Prognostic Implications of Mitral Regurgitation in Severe Aortic Stenosis

Circulation ◽

10.1161/circ.118.suppl_18.s_859-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Padmini Varadarajan ◽

Ramdas G Pai

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Independent Predictor ◽

Severe Aortic Stenosis ◽

Aortic Valve Area ◽

List Type ◽

Prognostic Implications ◽

Valve Area

Introduction: Mitral regurgitation (MR) is present in nearly half of the patients with severe aortic stenosis (AS). Risk factors for its development and its prognostic implications are not clear. Methods: Search of our echocardiographic database between 1993 to 2003 yielded 740 patients with severe AS defined as aortic valve area (AVA) ≤ 0.8cm2. Thorough chart reviews were conducted to collect clinical and pharmacological data. Mortality data was obtained from National death index. Results: Patient characteristics: age 74±13 years; females 60%, EF 54±20%, aortic valve area 0.67±0.17 cm2. MR grade ≥2+ were present in 339 (46%) patients: 2+ in 166 (22%), 3+ in 115 (16%) and 4+ in 58 (8%). There was a progressive decrease in survival with each grade of MR in the whole cohort as well as the surgically and medically treated subsets (p<0.0001, figure ). Presence of 3 and 4+ MR was associated with a larger LV (p<0.0001), lower EF (p<0.0001), greater age (p=0.0001), a smaller aortic valve area (p=0.001) and female gender (p=0.003). It remained an independent predictor of lower survival after adjusting for group differences using the Cox regression model. There was a lower AVR rate in those with 3 or 4+ MR compared to the rest (32 vs. 41%, p=0.03) despite a distinct independent survival advantage with AVR (RR 0.40, p<0.0001). Conclusion: Significant MR is present in nearly half of the patients with severe AS. The risk factors for its development include age, greater AS severity and LV dysfunction. It is an independent predictor of reduced survival.

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Choosing between velocity-time-integral ratio and peak velocity ratio for calculation of the dimensionless index (or aortic valve area) in serial follow-up of aortic stenosis

International Journal of Cardiology ◽

10.1016/j.ijcard.2012.04.105 ◽

2013 ◽

Vol 167 (4) ◽

pp. 1524-1531 ◽

Cited By ~ 12

Author(s):

Judith A. Finegold ◽

Charlotte H. Manisty ◽

Fabrizio Cecaro ◽

Nilesh Sutaria ◽

Jamil Mayet ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Peak Velocity ◽

Velocity Ratio ◽

Aortic Valve Area ◽

Velocity Time Integral ◽

Time Integral ◽

Integral Ratio ◽

Valve Area

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Faculty Opinions recommendation of Outcome implication of aortic valve area normalized to body size in asymptomatic aortic stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727057024.793527734 ◽

2017 ◽

Author(s):

Eric Brochet

Keyword(s):

Body Size ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Area ◽

Valve Area

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Prevalence and risk factors of aortic stenosis and aortic sclerosis: a 21-year follow-up of middle-aged men

Scandinavian Cardiovascular Journal ◽

10.1080/14017431.2019.1685126 ◽

2019 ◽

Vol 54 (2) ◽

pp. 115-123

Author(s):

Silvana Kontogeorgos ◽

Erik Thunström ◽

Carmen Basic ◽

Per-Olof Hansson ◽

You Zhong ◽

...

Keyword(s):

Risk Factors ◽

Aortic Stenosis ◽

Middle Aged ◽

Aortic Sclerosis

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P1692 The past returns after 20 years: a case report

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1055 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Habjan ◽

D Cantisani ◽

I S Scarfo` ◽

M C Guarneri ◽

G Semeraro ◽

...

Keyword(s):

Heart Disease ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Stenosis ◽

Valvular Heart Disease ◽

Radiation Treatment ◽

Severe Aortic Stenosis ◽

Aortic Valve Area ◽

Radiation Induced ◽

Valve Area

Abstract Introduction Radiation therapy is one of the cornerstones of treatment for many types of cancer. These patients can later in life develop cardiovascular complications associated with radiation treatment. Late cardiovascular effects of radiation treatment include coronary artery disease (CAD), valvular heart disease, congestive heart failure, pericardial disease and sudden death. The most common sign of radiation-induced valvular heart disease is the calcification of the intervalvular fibrosa between the aortic and mitral valve. Case presentation A 71-year-old male patient with a history of Non-Hodgkin lymphoma treated with radiotherapy and chemotherapy 20 years ago, CAD, arterial hypertension, diabetes type II, dyslipidemia, obesity and currently smoking presented in the emergency room in our medical facility with acute pulmonary edema. The patient had unstable angina pectoris in 2018, the coronary angiography showed two-vessel disease with a non-significant stenosis of the left main coronary artery (LMCA) and 70% stenosis of the left anterior descending artery (LAD), for which he refused the percutaneous coronary intervention. At the same time, a transthoracic echocardiography (TTE) showed severe aortic stenosis and moderately severe mitral stenosis, at that time the patient refused the operation. After the initial treatment for pulmonary edema, TTE and transesophageal echocardiography (TEE) were performed and showed a tricuspid aortic valve with calcification of the cusps and a very severe aortic stenosis (planimetric aortic valve area 0.74 cm², functional aortic valve area 0.55 cm², indexed functional aortic valve area 0.25 cm²/m², mean gradient 61 mmHg, peak gradient 100 mmHg, stroke volume (SV) 69 ml, stroke volume index (SVI) 31 ml/m², flow rate 221 ml/s, aortic annulus 20x26 mm). The left ventricle was severely dilated (end diastolic volume 268 ml) with diffuse hypokinesia and severe systolic dysfunction (ejection fraction 32%). We appreciated a calcification of the mitral-aortic intervalvular fibrosa and the mitral annulus, without mitral stenosis but with moderate mitral regurgitation. The calcification of the intervalvular fibrosa suggested our final diagnosis of radiation-induced valvular heart disease with a severe aortic stenosis in low-flow conditions. The patient was successfully treated with transcatheter aortic valve implantation (TAVI). Conclusion Radiation-induced heart disease is a common reality and is destinated to raise due to the increasing number of cancer survivors. Effects are seen also many years after the radiation treatment. The exact primary mechanism of radiation injury to the heart is still unknown. The treatment of radiation-induced valve disease is the same as the treatment of valve disease in the general population. Abstract P1692 Figure. Radiation-induced valvular heart disease

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