scholarly journals At what flow rate does aortic valve gradient become severely elevated? Implications for guideline recommendations on aortic valve area cutoffs

2021 ◽  
Author(s):  
Wilbert Aronow ◽  
Ayesha Salahuddin ◽  
Daniel Spevack
Keyword(s):  
Aortic Valve ◽  
Linear Regression ◽  
Aortic Stenosis ◽  
Flow Rate ◽  
Aortic Valve Area ◽  
Flow Rates ◽  
Wide Range ◽  
The Relationship ◽  
Valve Area

IntroductionSince many patients with AVA < 1.0 cm2 do not manifest a mAVG > 40 mmHg, we sought to determine the AVA at which mAVG tends to exceed 40 mmHg in a sample of subjects with varied transvalvular flow rates.Material and methodsWe selected 200 subjects with an AVA< 1.0 cm2. The sample was selected to include subjects with a varied mean systolic flow (MSF) rates. Linear regression was performed to determine the relationship between MSF and mAVG. Since this relationship varied by AVA, the regression was stratified by AVA (critical <0.6 cm2, severe 0.6-0.79 cm2 , moderately severe 0.8-0.99 cm2)ResultsThe study sample was 79 ± 12 years-old and was 60% female. The MSF rate at which mAVG tended to exceed 40 mmHg was 120 ml/s for critical AVA, 183 ml/s for severe AVA and 257 ml/s for moderately severe AVA. Those with moderately severe AVA rarely (8%) had a mAVG > 40 mmHg at a wide range of MSF. In contrast, those with severe AVA typically (75%) had mAVG > 40 mmHg when MSF was normal (>200 ml/s). Those with critical AVA frequently (44%) had mAVG > 40 mmHg, even when MSF was reduced.ConclusionsAVA > 0.8 cm2 was rarely associated with mAVG > 40 mmHg, even when transvalvular flow rate was normal. Consideration should therefore be given to either raising the cutoff AVA or lowering the mAVG at which aortic stenosis is considered severe.

scholarly journals Transvalvular Flow Rate Determines Prognostic Value of Aortic Valve Area in Aortic Stenosis

2020 ◽  
Vol 75 (15) ◽  
pp. 1758-1769 ◽  
Author(s):  
Mayooran Namasivayam ◽  
Wei He ◽  
Timothy W. Churchill ◽  
Romain Capoulade ◽  
Shiying Liu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Flow Rate ◽  
Prognostic Value ◽  
Aortic Valve Area ◽  
Valve Area

scholarly journals Resting Aortic Valve Area at Normal Transaortic Flow Rate Reflects True Valve Area in Suspected Low-Gradient Severe Aortic Stenosis

2015 ◽  
Vol 8 (10) ◽  
pp. 1133-1139 ◽  
Author(s):  
Navtej S. Chahal ◽  
Maria Drakopoulou ◽  
Ana M. Gonzalez-Gonzalez ◽  
Ramasamy Manivarmane ◽  
Rajdeep Khattar ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Flow Rate ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Valve Area

scholarly journals 107 Low-flow low-gradient aortic stenosis: aortic valve area estimated by continuity equation versus simplified method of projected aortic valve area

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J A Da Conceicao Pedro Pais ◽  
P Fazendas ◽  
A Marques ◽  
K Congo ◽  
A C Gomes ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Flow Rate ◽  
Continuity Equation ◽  
Low Dose ◽  
Low Flow ◽  
Aortic Valve Area ◽  
Simplified Method ◽  
Valve Area

Abstract Introduction The evaluation of real severity of "low-flow low-gradient" aortic stenosis (LFLG AS) is particularly challenging. TOPAS study demonstrated that projected aortic valve area at a normal transvalvular flow rate (AVAproj) derived from dobutamine stress echocardiography (DSE) is superior to the traditional Doppler indices to discriminate true severe-AS and pseudosevere-AS. Purpose To compare two echocardiographic methods to estimate severity of LFLG AS with DSE (aortic valve area (AVA) estimated by continuity equation (AVA-CE) and simplified method of AVAproj) in patients (pts) with low transvalvular flow rate (&lt;250mL/seg). Methods Unicentric, retrospective study, that included pts with LFLG AS undergoing DSE with low dose dobutamine protocol, during Nov 2013-Dec 2018 period. Evaluation at rest and peak DSE of vital signs, mean transaortic gradient, aortic VTI, LVOT VTI and VTI ratio, valvulo-arterial impedance (ZVA), AVA-CE, simplified method of AVAproj and global longitudinal strain (GLS). Results A total of 27 DSE were performed in 23 different pts, mean age of 76 ± 8 years, 82% male. At rest 55% in sinus rhythm, mean heart rate (HR) was 76 ± 12 bpm, mean systolic arterial pressure (SAP) was 122 ± 22 mmHg, mean ZVA 4.3 ± 2 mmHg/ml/m2; mean diameter of LVOT was 21,7 ± 2,6cm, mean of mean aortic gradients 21 ± 7 mmHg, 67% of pts had a VTI ratio at rest compatible with severe AS and remaining compatible with moderate AS. Estimated mean AVA-CE was 0.86 ± 0.29 cm2 with 67% of pts classified as severe AS. Mean left ventricular ejection fraction at rest was 31 ± 9%, systolic volume index 28,7 ± 8 mL/m2 and GLS -5,9%. During low dose perfusion protocol of dobutamine 100% patients remained asymptomatic, mean HR was 110 ± 25 bpm, mean SAP was 123 ± 26 mmHg, mean ZVA 3.6 ± 1.7 mmHg/mL/m2, mean of mean aortic gradients 28 ± 9mmHg, 37% of pts presented VTI ratio compatible with severe AS and remaining compatible with moderate AS. Mean flow reserve was 16 ± 16% and mean GLS-7.2%. AVA-CE was 1,06 ± 0,35 cm2 with 56% of pts classified as severe AS and mean projected AVA was 1.01 ± 0.22cm2, without significant difference in AVA estimated by the two methods (p = 0.344). Projected AVA allowed re-classification of AS in 22% of pts (5 patients), with 31% of severe AS reclassified as moderate AS while AVA-CE allowed re-classification in 13% (3 patients), with 19% of severe AS reclassified as moderate AS. Considering medium follow up of 24 months, 6 patients were submitted aortic valve replacement surgery and another 6 patients to transcatheter aortic valve replacement. The simplified projected valve area calculation show no significant therapeutic impact in the selection of this patients. Conclusion The simplified projected valve area calculation is technically feasible and accessible. This study shows a good correlation in pts with low cardiac flow. If AVAproj method had been used 2 extra patients would have been reclassified during DSE.

Preoperative Computed Tomography Angiography Reveals Leaflet-Specific Calcification and Excursion Patterns in Aortic Stenosis

2021 ◽  
Author(s):  
Ian Y. Chen ◽  
Vijay Vedula ◽  
Sachin B. Malik ◽  
Tie Liang ◽  
Andrew Y. Chang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Linear Regression ◽  
Aortic Stenosis ◽  
Computed Tomography Angiography ◽  
Aortic Valve Area ◽  
Male Patients ◽  
Coronary Cusp ◽  
The Right ◽  
Valve Area

Background: Computed tomography–based evaluation of aortic stenosis (AS) by calcium scoring does not consider interleaflet differences in leaflet characteristics. Here, we sought to examine the functional implications of these differences. Methods: We retrospectively reviewed the computed tomography angiograms of 200 male patients with degenerative calcific AS undergoing transcatheter aortic valve replacement and 20 male patients with normal aortic valves. We compared the computed tomography angiography (CTA)-derived aortic valve leaflet calcification load (AVLC CTA ), appearance, and systolic leaflet excursion (LE sys ) of individual leaflets. We performed computer simulations of normal valves to investigate how interleaflet differences in LE sys affect aortic valve area. We used linear regression to identify predictors of leaflet-specific calcification in patients with AS. Results: In patients with AS, the noncoronary cusp (NCC) carried the greatest AVLC CTA (365.9 [237.3–595.4] Agatston unit), compared to the left coronary cusp (LCC, 278.5 [169.2–478.8] Agatston unit) and the right coronary cusp (RCC, 240.6 [137.3–439.0] Agatston unit; both P <0.001). However, LCC conferred the least LE sys (42.8º [38.8º–49.0º]) compared to NCC (44.8º [41.1º–49.78º], P =0.001) and RCC (47.7º [42.0º–52.3º], P <0.001) and was more often characterized as predominantly thickened (23.5%) compared to NCC (12.5%) and RCC (16.5%). Computer simulations of normal valves revealed greater reductions in aortic valve area following closures of NCC (−32.2 [−38.4 to −25.8]%) and RCC (−35.7 [−40.2 to −32.9]%) than LCC (−24.5 [−28.5 to −18.3]%; both P <0.001). By linear regression, the AVLC CTA of NCC and RCC, but not LCC, predicted LE sys (both P <0.001) in patients with AS. Both ostial occlusion and ostial height of the right coronary artery predicted AVLC CTA, RCC ( P =0.005 and P =0.001). Conclusions: In male patients, the AVLC CTA of NCC and RCC contribute more to AS than that of LCC. LCC’s propensity for noncalcific leaflet thickening and worse LE sys , however, should not be underestimated when using calcium scores to assess AS severity.

scholarly journals Size-adjusted aortic valve area: refining the definition of severe aortic stenosis

2020 ◽  
Author(s):  
Branka Vulesevic ◽  
Naozumi Kubota ◽  
Ian G Burwash ◽  
Claire Cimadevilla ◽  
Sarah Tubiana ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Predictive Accuracy ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Obese Patients ◽  
Derivation Cohort ◽  
Wide Range ◽  
Definition Of ◽  
Diagnostic And Prognostic Value ◽  
Valve Area

Abstract Aims Severe aortic valve stenosis (AS) is defined by an aortic valve area (AVA) &lt;1 cm2 or an AVA indexed to body surface area (BSA) &lt;0.6 cm/m2, despite little evidence supporting the latter approach and important intrinsic limitations of BSA indexation. We hypothesized that AVA indexed to height (H) might be more applicable to a wide range of populations and body morphologies and might provide a better predictive accuracy. Methods and results In 1298 patients with degenerative AS and preserved ejection fraction from three different countries and continents (derivation cohort), we aimed to establish an AVA/H threshold that would be equivalent to 1.0 cm2 for defining severe AS. In a distinct prospective validation cohort of 395 patients, we compared the predictive accuracy of AVA/BSA and AVA/H. Correlations between AVA and AVA/BSA or AVA/H were excellent (all R2 &gt; 0.79) but greater with AVA/H. Regressions lines were markedly different in obese and non-obese patients with AVA/BSA (P &lt; 0.0001) but almost identical with AVA/H (P = 0.16). AVA/BSA values that corresponded to an AVA of 1.0 cm2 were markedly different in obese and non-obese patients (0.48 and 0.59 cm2/m2) but not with AVA/H (0.61 cm2/m for both). Agreement for the diagnosis of severe AS (AVA &lt; 1 cm2) was significantly higher with AVA/H than with AVA/BSA (P &lt; 0.05). Similar results were observed across the three countries. An AVA/H cut-off value of 0.6 cm2/m [HR = 8.2(5.6–12.1)] provided the best predictive value for the occurrence of AS-related events [absolute AVA of 1 cm2: HR = 7.3(5.0–10.7); AVA/BSA of 0.6 cm2/m2 HR = 6.7(4.4–10.0)]. Conclusion In a large multinational/multiracial cohort, AVA/H was better correlated with AVA than AVA/BSA and a cut-off value of 0.6 cm2/m provided a better diagnostic and prognostic value than 0.6 cm2/m2. Our results suggest that severe AS should be defined as an AVA &lt; 1 cm2 or an AVA/H &lt; 0.6 cm2/m rather than a BSA-indexed value of 0.6 cm2/m2.

scholarly journals P1692 The past returns after 20 years: a case report

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

Quantitation of aortic valve area in aortic stenosis with multiplane transesophageal echocardiography: Comparison with monoplane transesophageal approach

1994 ◽  
Vol 128 (3) ◽  
pp. 526-532 ◽  
Author(s):  
Christophe Tribouilloy ◽  
Wei Feng Shen ◽  
Marcel Peltier ◽  
Anfani Mirode ◽  
Jean-Luc Rey ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Aortic Valve Area ◽  
Valve Area

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
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