scholarly journals Letter by Poullis and Warwick Regarding Article, “Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction Is Associated With Higher Afterload and Reduced Survival”

Circulation ◽  
2007 ◽  
Vol 116 (25) ◽  
Author(s):  
Michael Poullis ◽  
Richard Warwick
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Preserved Ejection Fraction

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

scholarly journals P1366 Low-flow, low-gradient severe aortic stenosis: might mitral regurgitation be a culprit?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ferreira ◽  
M Beringuilho ◽  
D Faria ◽  
D Roque ◽  
H Ferreira ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Stroke Volume ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Preserved Ejection Fraction

Abstract Introduction According to current guidelines, given a patient with low-gradient (aortic valve maximum velocity < 4m/s and/or aortic valve mean gradient <40mmHg), aortic valve area (AVA) < 1cm2 and low-flow (stroke volume (SV) < 35mL/min/m2), with preserved left ventricle function (ejection fraction (EF) ≥50%), an integrated approach for assessment of aortic stenosis severity is proposed. We aimed to investigate whether mitral regurgitation can play a role in those cases, possibly being responsible for low antegrade systolic flow. Methods We retrospectively analysed 121 consecutive transthoracic echocardiograms (TTEs) of patients with severe aortic stenosis, with AVA < 1.0cm2 as assessed by continuity equation. Patients with low ejection fraction (< 50%) were excluded. We therefore included 84 patients (females 53,6%, mean age 79,1+-10 years). Stroke volume was assessed by Doppler at the left ventricle outflow tract (LVOT). We then compared the prevalence of more than mild mitral regurgitation among patients with low-gradient and low-flow and the other patients. Results 15 patients had both low-gradient, low-flow and preserved ejection fraction. There was a significant association regarding the presence of more than mild mitral regurgitation among these patients (p = 0.028, OR = 4.7, CI 95% 1.1-20.1). In these patients, it was also observed a higher prevalence of atrial fibrillation (p = 0.03, OR = 6.9, CI 95% 1.74-27.1), lower longitudinal systolic function of right ventricle as measured by TAPSE (16.6 vs 21.5mm, p = 0.028), and a tendency towards higher left atrial volume (113 vs 87mL, p = 0.06). Conclusions Given the findings that the prevalence of more than mild mitral regurgitation is higher in patients with severe aortic stenosis as assessed by AVA with both low-gradient, low-flow and preserved ejection fraction, we suggest that the presence of more than mild mitral regurgitation should be considered on the approach of aortic stenosis classification of these patients.

scholarly journals Prognostic Value of Global Longitudinal Strain in Paradoxical Low-Flow, Low-Gradient Severe Aortic Stenosis With Preserved Ejection Fraction

2014 ◽  
Vol 78 (11) ◽  
pp. 2750-2759 ◽  
Author(s):  
Kimi Sato ◽  
Yoshihiro Seo ◽  
Tomoko Ishizu ◽  
Masaaki Takeuchi ◽  
Masaki Izumo ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Low Flow ◽  
Preserved Ejection Fraction
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