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Low flow aortic stenosis

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https://www.readbyqxmd.com/read/29124471/clinical-outcome-and-functional-characteristics-of-patients-with-asymptomatic-low-flow-low-gradient-severe-aortic-stenosis-with-preserved-ejection-fraction-are-closer-to-high-gradient-severe-than-to-moderate-aortic-stenosis
#1
Mohammad Kavianipour, Amir Farkhooy, Frank A Flachskampf
Asymptomatic "paradoxic" severe low-flow low-gradient aortic stenosis with preserved ejection fraction (PAS) constitutes a challenging condition where the optimal management and follow-up remain elusive. We evaluated the clinical outcome in patients with PAS as compared to asymptomatic patients with moderate (MAS) or classical severe aortic stenosis (CAS). Consecutive asymptomatic moderate or severe aortic stenosis patients without concomitant other heart or lung disease (n = 121) were invited. Participants (n = 74) were assigned to three subgroups with regard to degree of aortic stenosis: MAS (n = 25), CAS (n = 22) and PAS (n = 27)...
November 9, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/29055632/intervention-versus-observation-in-symptomatic-patients-with-normal-flow-low-gradient-severe-aortic-stenosis
#2
Oren Zusman, Gregg S Pressman, Shmuel Banai, Ariel Finkelstein, Yan Topilsky
OBJECTIVES: To describe patients with severe symptomatic aortic stenosis with normal flow and low gradients and determine whether they benefit from intervention. BACKGROUND: Severe symptomatic aortic stenosis is a progressive disease with high mortality. Although surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) are indicated for patients with high gradients (>40 mm Hg) or low gradients due to low flow, the approach for patients with normal flow and low gradients is poorly defined...
October 14, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29040507/aortic-valve-replacement-improves-survival-in-severe-aortic-stenosis-with-gradient-area-mismatch
#3
Yujing Mo, Guy Van Camp, Giuseppe Di Gioia, Emanuele Barbato, Tomas Ondrus, Filip Casselman, Marc Vanderheyden, Bernard De Bruyne, Jozef Bartunek, Martin Penicka
OBJECTIVES: To investigate whether and in which patients with catheter-derived low pressure gradient (PG, <40 mmHg) severe (aortic valve area ≤ 1 cm2) aortic stenosis and preserved left ventricular ejection fraction, early aortic valve replacement (AVR) might improve survival. METHODS: We investigated a total of 506 consecutive patients (age 75 ± 9 years, 58% men) with either moderate aortic stenosis (MAS) or severe aortic stenosis (SAS) and preserved left ventricular ejection fraction (≥50%) as defined at catheterization...
October 13, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29033387/survival-and-cause-of-death-after-transcatheter-aortic-valve-replacement-as-compared-to-an-age-and-sex-matched-background-population
#4
Marie Theut, Julie B Thygesen, Ole De Backer, Lars Søndergaard
AIMS: This study aimed to assess survival and causes of death in a real-world TAVR population as compared to an age- and sex-matched background population. METHODS AND RESULTS: Each aortic stenosis (AS) patient treated with TAVR in Eastern Denmark between 2007 and 2014 (n=617) was matched with 25 age- and sex-matched controls (n=15,425) randomly drawn from the general Danish population. In the total TAVR population, early mortality (≤90 days) was significantly higher (hazard ratio [HR] 3...
October 13, 2017: EuroIntervention
https://www.readbyqxmd.com/read/29029006/large-scale-assessment-of-aortic-stenosis-facing-the-next-cardiac-epidemic
#5
Javier Ramos, Juan Manuel Monteagudo, Teresa González-Alujas, María Eugenia Fuentes, Marta Sitges, María Luisa Peña, Fernando Carrasco-Chinchilla, Tomás Echeverría, Alberto Bouzas, José Francisco Forteza Alberti, Dolores Mesa, Jesús María De La Hera, José Luis Zamorano
Aims: Aortic stenosis (AS) is the most frequent valvular disease in developed countries. As society grows older, the prevalence of AS increases. However, the real burden, current aetiology, severity distribution, and echocardiographic patterns of AS are not fully clear. The aim of the present study is to provide an accurate overall picture of AS, focusing on its epidemiology, aetiology, and echocardiographic features. Methods and results: A total of 29 502 consecutive echocardiograpies were prospectively included in this multicentre study...
September 28, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/29021259/preload-stress-echocardiography-predicts-outcomes-in-patients-with-preserved-ejection-fraction-and-low-gradient-aortic-stenosis
#6
Kenya Kusunose, Hirotsugu Yamada, Susumu Nishio, Yuta Torii, Yukina Hirata, Hiromitsu Seno, Yoshihito Saijo, Takayuki Ise, Koji Yamaguchi, Shusuke Yagi, Takeshi Soeki, Tetsuzo Wakatsuki, Masataka Sata
BACKGROUND: The projected aortic valve area (AVAproj) at a normal transvalvular flow rate using dobutamine is helpful to determine the actual severity of aortic stenosis (AS) and to predict risk of adverse events in low-gradient AS cases with unclear surgical indication. Our study aimed to identify the independent and incremental value of preload stress echocardiography-derived AVAproj to predict outcomes in patients with preserved ejection fraction and low-gradient AS. METHODS AND RESULTS: We prospectively performed echocardiographic studies in 79 patients with low-gradient AS (age, 77±7 years; 30% men) with preload stress echocardiography using leg positive pressure...
October 2017: Circulation. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29019612/unveiling-transthyretin-cardiac-amyloidosis-and-its-predictors-among-elderly-patients-with-severe-aortic-stenosis-undergoing-transcatheter-aortic-valve-replacement
#7
Adam Castaño, David L Narotsky, Nadira Hamid, Omar K Khalique, Rachelle Morgenstern, Albert DeLuca, Jonah Rubin, Codruta Chiuzan, Tamim Nazif, Torsten Vahl, Isaac George, Susheel Kodali, Martin B Leon, Rebecca Hahn, Sabahat Bokhari, Mathew S Maurer
Aims: Transthyretin cardiac amyloidosis (ATTR-CA) has been reported in patients with aortic stenosis (AS) but its prevalence and phenotype are not known. We examine elderly patients with severe symptomatic AS undergoing transcatheter aortic valve replacement (TAVR) and determine the prevalence and phenotype of ATTR-CA non-invasively. Methods and results: We performed technetium-99m pyrophosphate (99mTc-PYP) cardiac scintigraphy prospectively on patients who underwent TAVR, to screen for ATTR-CA...
October 7, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28994654/impact-of-concomitant-mitral-regurgitation-on-transvalvular-gradient-and-flow-in-severe-aortic-stenosis-a-systematic-ex-vivo-analysis-of-a-subentity-of-low-flow-low-gradient-aortic-stenosis
#8
Felix Katte, Marcus Franz, Christian Jung, Hans R Figulla, David M Leistner, Philipp Jakob, Barbara E Stähli, Daniel Kretzschmar, Alexander Lauten
AIMS: Evaluation of aortic stenosis(AS) is based on measurement of mean transvalvular gradient(MPG), flow velocity(vmax) and aortic valve area(AVA). Objective of the present study was to analyse the impact of systemic hemodynamic variables and concomitant mitral regurgitation(MR) on aortic MPG, vmax and AVA in severe AS. METHODS AND RESULTS: A pulsatile circulatory model was designed to study function and interdependence of stenotic aortic and insufficient mitral prosthetic valves (n=8; effective regurgitation orifice (EROA)<0...
October 10, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28950336/apical-four-chamber-longitudinal-left-ventricular-strain-in-patients-with-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction-analysis-related-with-flow-gradient-pattern-and-association-with-outcome
#9
Erwan Salaun, Anne-Claire Casalta, Erwan Donal, Yohann Bohbot, Elena Galli, Christophe Tribouilloy, Sandrine Hubert, Julien Magne, Julien Mancini, Sebastien Renard, Jean-Francois Avierinos, Laurie-Anne Maysou, Cécile Lavoute, Catherine Szymanski, Julie Haentjens, Gilbert Habib
Aims: To evaluate the prognostic value of apical four-chamber (A4-C) longitudinal strain (LS) in patients with aortic stenosis (AS). Methods and results: In a multicentre cohort, 582 patients (74.3 ± 10.9 years) with moderate or severe AS and preserved left ventricular (LV) ejection fraction (≥50%) were included in this retrospective study. Patients with severe AS were classified in four subgroups according to flow and gradient: low flow (LF) was defined as a stroke volume index <35 mL/m2 compared with normal flow (NF); low-gradient (LG) as a mean gradient <40 mmHg compared with high gradient (HG)...
August 10, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28950322/concomitant-mitral-regurgitation-and-aortic-stenosis-one-step-further-to-low-flow-preserved-ejection-fraction-aortic-stenosis
#10
Giovanni Benfari, Marie-Annick Clavel, Stefano Nistri, Caterina Maffeis, Corrado Vassanelli, Maurice Enriquez-Sarano, Andrea Rossi
Aims: Patients with severe aortic stenosis (AS) and normal ejection fraction (EF) can paradoxically present low-transaortic flow and worse prognosis. The role of co-existing mitral regurgitation (MR) in determining this haemodynamic inconsistency has never been quantitatively explored. The hypothesis is that MR influences forward stroke volume and characterizes the low-flow AS pattern. Methods and results: Consecutive patients with indexed aortic valve area (AVA) ≤0...
July 27, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28941480/a-double-crossover-technique-in-an-obese-patient-undergoing-transfemoral-transcatheter-aortic-valve-implantation-how-to-accomplish-hemostasis-percutaneously
#11
Hirokazu Onishi, Toru Naganuma, Sunao Nakamura
Percutaneous transfemoral transcatheter aortic valve implantation (TF-TAVI) is generally an acceptable procedure but may be associated with vascular complications at femoral access sites, particularly in obese patients. This report aimed to describe a case of successful performance of our "double crossover technique" in an obese patient undergoing TF-TAVI with a percutaneous transfemoral intra-aortic balloon pump (TF-IABP). A 75-year-old man presented with heart failure due to a left ventricular ejection fraction of 35% and low-flow, low-gradient severe aortic stenosis...
September 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28917673/b-type-natriuretic-peptide-and-high-sensitivity-cardiac-troponin-for-risk-stratification-in-low-flow-low-gradient-aortic-stenosis-a-substudy-of-the-topas-study
#12
Abdellaziz Dahou, Marie-Annick Clavel, Romain Capoulade, Kim O'Connor, Henrique B Ribeiro, Nancy Côté, Florent Le Ven, Josep Rodés-Cabau, Jean G Dumesnil, Patrick Mathieu, Philippe Pibarot
OBJECTIVES: The objective of this study was to determine the prognostic value of combined measures of B-type natriuretic peptide (BNP) and high-sensitivity cardiac troponin T (hsTnT) in patients with low-flow, low-gradient aortic stenosis (LF-LG AS) who had either a preserved or reduced left ventricular ejection fraction (LVEF). BACKGROUND: An elevated BNP level is associated with increased risk of mortality in patients with LF-LG AS. The incremental prognostic value of hsTnT in these patients is unknown...
September 9, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28901639/predicting-changes-in-flow-category-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction-on-medical-therapy
#13
Jinghao Nicholas Ngiam, Ivandito Kuntjoro, Benjamin Y Q Tan, Hui-Wen Sim, William K F Kong, Tiong-Cheng Yeo, Kian-Keong Poh
BACKGROUND/OBJECTIVES: Controversy surrounds the prognosis and management of patients with paradoxical low-flow severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). It was not certain if patients in a particular flow category remained in the same category as disease progressed. We investigated whether there were switches in categories and if so, their predictors. METHODS: Consecutive subjects (n = 203) with isolated severe AS and paired echocardiography (>180 days apart) were studied...
September 13, 2017: Echocardiography
https://www.readbyqxmd.com/read/28893490/partial-renal-coverage-in-endovascular-aneurysm-repair-causes-unfavorable-renal-flow-patterns-in-an-infrarenal-aneurysm-model
#14
Lennart van de Velde, Esmé J Donselaar, Erik Groot Jebbink, Johannes T Boersen, Guillaume P R Lajoinie, Jean-Paul P M de Vries, Clark J Zeebregts, Michel Versluis, Michel M P J Reijnen
OBJECTIVE: To achieve an optimal sealing zone during endovascular aneurysm repair, the intended positioning of the proximal end of the endograft fabric should be as close as possible to the most caudal edge of the renal arteries. Some endografts exhibit a small offset between the radiopaque markers and the proximal fabric edge. Unintended partial renal artery coverage may thus occur. This study investigated the consequences of partial coverage on renal flow patterns and wall shear stress (WSS)...
September 8, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28882231/hemodynamic-response-to-nitroprusside-in-patients-with-low-gradient-severe-aortic-stenosis-and-preserved-ejection-fraction
#15
COMPARATIVE STUDY
James W Lloyd, Rick A Nishimura, Barry A Borlaug, Mackram F Eleid
BACKGROUND: Low-gradient severe aortic stenosis (LGSAS) with preserved ejection fraction (EF) is incompletely understood. The influence of arterial afterload and diastolic dysfunction on the hemodynamic presentation of LGSAS remains unknown. OBJECTIVES: The authors sought to determine the acute hemodynamic response to sodium nitroprusside in LGSAS with preserved EF. METHODS: Symptomatic patients with LGSAS and preserved EF underwent cardiac catheterization with comparison of hemodynamic measurements before and after nitroprusside...
September 12, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28870874/characteristics-and-outcome-following-transcatheter-aortic-valve-replacement-of-patients-with-severe-aortic-stenosis-with-low-flow
#16
Yigal Abramowitz, Tarun Chakravarty, Philippe Pibarot, Yoshio Maeno, Hiroyuki Kawamori, David Anderson, Geeteshwar Mangat, Mamoo Nakamura, Wen Cheng, Raj R Makkar
AIMS: Only few studies examined the respective impact of low flow (LF), low gradient (LG) and low ejection fraction (LEF) on outcomes following transcatheter aortic valve replacement (TAVR). The purpose of this study was to assess the impact of pre-procedural stroke volume index, aortic valve gradient, left ventricular ejection fraction (LVEF) and different flow/gradient/LVEF patterns on the clinical outcomes of patients with severe aortic stenosis (AS) that undergo TAVR. METHODS AND RESULTS: We analyzed the clinical, echocardiographic, and outcome data collected in 770 patients with AS that underwent TAVR...
September 5, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28867024/impact-of-stroke-volume-assessment-by-integrating-multi-detector-computed-tomography-and-doppler-data-on-the-classification-of-aortic-stenosis
#17
Barbara E Stähli, Thomas Stadler, Erik W Holy, Thi Dan Linh Nguyen-Kim, Lisa Hoffelner, Ladina Erhart, Slayman Obeid, Markus Niemann, Rolf Jenni, Sandra Hamada, Robert Manka, Thomas F Lüscher, Francesco Maisano, Fabian Nietlispach, Thomas Frauenfelder, Felix C Tanner
BACKGROUND: The prevalence of low flow low gradient (LFLG) severe aortic stenosis (AS) may be overrated due to underestimation of stroke volume in two-dimensional (2D) echocardiography. The implications of 3D imaging on stroke volume calculation for AS classification have not been elucidated. Integrating multi-detector computed tomography (MDCT) and Doppler data may improve diagnostic accuracy in patients with LFLG AS. METHODS: A total of 186 patients with severe AS evaluated for transcatheter aortic valve replacement were classified according to indexed stroke volume (SVI, cut-off 35mL/m(2)) and mean transaortic pressure gradient (cut-off 40mmHg)...
November 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28864136/severe-aortic-stenosis-patients-with-preserved-ejection-fraction-according-to-flow-and-gradient-classification-prevalence-and-outcomes
#18
Ariana González Gómez, Covadonga Fernández-Golfín, Juan Manuel Monteagudo, Carlos Izurieta, Rocío Hinojar, Ana García, Eduardo Casas, José Julio Jiménez-Nacher, José Luis Moya, Soledad Ruiz, José Luis Zamorano
BACKGROUND: Clinicians often encounter patients with apparently discordant echocardiographic findings, severe aortic stenosis (SAS) defined by aortic valve area (AVA) despite a low mean gradient. A new classification according to flow state and pressure gradient has been proposed. We sought to assess the prevalence, characteristics and outcomes of patients with asymptomatic SAS with preserved left-ventricular ejection fraction (LVEF) according to flow and gradient. METHODS AND RESULTS: In total 442 patients with SAS (AVAi<0...
December 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28846524/outcome-of-patients-with-low-flow-low-gradient-severe-aortic-stenosis-who-underwent-aortic-valve-replacement
#19
Xing Li Fan, Jiajun Zhang, Chong Wang, Hongmei Chong, Guanxin Zhang, Qing Xue, Yangfeng Tang, Lin Han
It is well-documented that stroke volume and gradient are indexed to classify patients with aortic stenosis into several phenotypes. The purpose of the present study was to estimate the impact of stroke volume and gradient on the clinical outcome of patients with AS who have undergone aortic valve replacement. Methods: A total of 154 consecutive patients were studied. They all had severe aortic stenosis (aortic valve area [AVA] ≤ 1 cm², left ventricular ejection fraction [LVEF] ≥ 50%) and underwent aortic valve replacement (AVR) from January 1, 2004 to December 31, 2010...
July 20, 2017: Heart Surgery Forum
https://www.readbyqxmd.com/read/28828046/modern-use-of-echocardiography-in-transcatheter-aortic-valve-replacement-an-up-date
#20
Cristina Caldararu, Serban Balanescu
Echocardiography is the cornerstone in the diagnosis of any valvular heart disease. The accurate diagnosis of aortic stenosis, the left ventricle function and the other heart valves evaluation are currently done by ultrasound alone. Prosthetic valve choice and dimensions prior to implantation can be done solely by proper use of echocardiography. The emergence of new methods to cure aortic stenosis such as trans-catheter aortic valve replacement (TAVR) emphasized the diagnostic value of cardiac ultrasound. The usefulness of echocardiography in TAVR can be divided in the baseline assessment (common to patients treated by conventional surgery), intra-procedural guidance of valve deployment and post-procedural follow-up...
December 2016: Mædica
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