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Low flow aortic stenosis

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https://www.readbyqxmd.com/read/28814490/clinical-features-and-prognosis-of-patients-with-isolated-severe-aortic-stenosis-and-valve-area-less-than-1-0-cm-2
#1
Praveen Mehrotra, Katrijn Jansen, Timothy C Tan, Aidan Flynn, Judy W Hung
OBJECTIVE: Current guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)≤1.0 cm(2), but some authors have suggested that the AVA cut-off be decreased to 0.8 cm(2). The aim of this study was, therefore, to better describe the clinical features and prognosis of patients with an AVA of 0.8-0.99 cm(2). METHODS: Patients with isolated, severe AS and ejection fraction ≥55% with an AVA of 0.8-0.99 cm(2) (n=105) were compared with those with an AVA<0...
August 16, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28808772/longitudinal-strain-assessed-by-cardiac-magnetic-resonance-correlates-to-hemodynamic-findings-in-patients-with-severe-aortic-stenosis-and-predicts-positive-remodeling-after-transcatheter-aortic-valve-replacement
#2
Dominik Buckert, Maciej Cieslik, Raid Tibi, Michael Radermacher, Volker Rasche, Peter Bernhardt, Vinzenz Hombach, Wolfgang Rottbauer, Jochen Wöhrle
AIMS: To assess left-ventricular strain parameters before and after transcatheter aortic valve replacement (TAVR) by feature tracking cardiac magnetic resonance imaging (FT CMR) and to correlate the findings to hemodynamic state and left-ventricular remodeling. METHODS AND RESULTS: Patients with symptomatic AS underwent FT CMR before and after TAVR. Patients were carefully evaluated by a comprehensive work-up including CMR, echocardiography and left and right heart catheterization...
August 14, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28797414/lower-transaortic-flow-rate-is-associated-with-increased-mortality-in-aortic-valve%C3%A2-stenosis
#3
Sahrai Saeed, Roxy Senior, Navtej S Chahal, Mai Tone Lønnebakken, John B Chambers, Edda Bahlmann, Eva Gerdts
OBJECTIVES: The association of transaortic flow rate (FR) with outcomes was tested in 1,661 patients with aortic valve stenosis (AS) in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. BACKGROUND: Low transaortic flow may complicate grading of AS. However, the association of lower transaortic FR with adverse outcomes has not been reported. METHODS: Transaortic FR was calculated from Doppler-derived stroke volume in milliliters divided by systolic ejection time in seconds and considered low if <200 ml/s...
August 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28794053/low-flow-severe-aortic-stenosis-evolving-role-of-transcatheter-aortic-valve-replacement
#4
REVIEW
Matthew D Saybolt, Paul N Fiorilli, Zachary M Gertz, Howard C Herrmann
The definition of severe aortic stenosis has classically and retrospectively been based on the natural history of patients with medically managed aortic stenosis and preserved left ventricular function in an era where surgical aortic valve replacement was the sole therapy. We now recognize that this disease is more heterogeneous and includes important subsets of patients with low stroke volume index (low flow) and low-gradient with reduced (classical) or preserved (paradoxical) ejection fraction. These patients pose diagnostic and treatment dilemmas, requiring a comprehensive assessment with integration of multimodality imaging, testing, and clinical assessment...
August 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28781116/acceleration-time-and-ratio-of-acceleration-time%C3%A2-to-ejection-time-in-aortic-stenosis-new%C3%A2-echocardiographic-diagnostic-parameters
#5
Sergio Gamaza-Chulián, Enrique Díaz-Retamino, Santiago Camacho-Freire, Dolores Ruiz-Fernández, Alejandro Gutiérrez-Barrios, Jesús Oneto-Otero
BACKGROUND: Inconsistencies between gradients and aortic valve area are frequent in the echocardiographic evaluation of aortic stenosis (AS). Assessing AS severity is essential for the correct management of the disease. The aim of this study was to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), could be diagnostic parameters in patients with AS. METHODS: Patients with AS (aortic peak velocity > 2 m/sec) were prospectively enrolled...
August 3, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28735253/how-should-i-treat-a-patient-with-a-symptomatic-and-severe-low-flow-low-gradient-aortic-stenosis-and-an-incidental-abdominal-aortic-aneurysm
#6
Zouhair Rahhab, Sander Ten Raa, Nathalie van der Ploeg, Nicolas M Van Mieghem, Hence Verhagen, Peter P T de Jaegere, Mani Arsalan, Won Kim, Thomas Walther, Didier Tchétché
No abstract text is available yet for this article.
July 20, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28715078/polish-stress-echocardiography-registry-pol-stress-registry-a-multicenter-study-stress-echo-in-poland-numbers-settings-results-and-complications
#7
Edyta Płońska-Gościniak, Jarosław D Kasprzak, Szymon Olędzki, Jolanta Rzucidło-Resil, Piotr Gościniak, Tomasz Kukulski, Katarzyna Mizia-Stec, Wojciech Kosmala, Dariusz Kosior, Marta Marcinkiewicz-Siemion, Barbara Brzezińska, Beata Zaborska, Marcin Fijałkowski, Iwona Świątkiewicz, Andrzej Szyszka, Jan Błażejewski, Wojciech Witkiewicz, Zbigniew Gąsior, Danuta Sorysz, Agnieszka Olszanecka
BACKGROUND: Stress echocardiography (SE) is widely used in Europe. No collective data have been available on the use of SE in Poland until now. AIM: To evaluate the number of SE investigations performed in Poland, their settings, complications and results. METHODS: In this retrospective survey, referral cardiology centers in Poland were asked to fill in a questionnaire regarding SE examinations performed from May 01, 2014 to May 01, 2015. RESULTS: The study included data from 17 university hospitals and large community hospitals which performed 4611 SE examinations, including 4408 tests in patients investigated for coronary artery disease (CAD) and 203 tests to evaluate valvular heart disease (VHD)...
July 17, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28698585/effects-of-aortic-valve-replacement-on-severe-aortic-stenosis-and-preserved-systolic-function-systematic-review-and-network-meta-analysis
#8
Qishi Zheng, Andie H Djohan, Enghow Lim, Zee Pin Ding, Lieng H Ling, Luming Shi, Edwin Shih-Yen Chan, Calvin Woon Loong Chin
The survival benefits of aortic valve replacement (AVR) in the different flow-gradient states of severe aortic stenosis (AS) is not known. A comprehensive search in PubMed/MEDLINE, Embase, Cochrane Library, CNKI and OpenGrey were conducted to identify studies that investigated the prognosis of severe AS (effective orifice area ≤1.0 cm(2)) and left ventricular ejection fraction ≥50%. Severe AS was stratified by mean pressure gradient [threshold of 40 mmHg; high-gradient (HG) and low-gradient (LG)] and stroke volume index [threshold of 35 ml/m(2); normal-flow (NL) and low-flow (LF)]...
July 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28687561/impact-of-vascular-hemodynamics-on-aortic-stenosis-evaluation-new-insights-into-the-pathophysiology-of-normal-flow-small-aortic-valve-area-low-gradient-pattern
#9
Nancy Côté, Louis Simard, Anne-Sophie Zenses, Lionel Tastet, Mylène Shen, Marine Clisson, Marie-Annick Clavel
BACKGROUND: About 50% of normal-flow/low-gradient patients (ie, low mean gradient [MG] or peak aortic jet velocity and small aortic valve area) have severe aortic valve calcification as measured by computed tomography. However, they are considered to have moderate aortic stenosis (AS) in current American College of Cardiology/American Heart Association guidelines. The objective was thus to evaluate the effect of hypertension and reduced arterial compliance (rAC) on MG and Vpeak measurements...
July 7, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28684437/the-role-and-clinical-implications-of-diastolic-dysfunction-in-aortic-stenosis
#10
REVIEW
Polydoros N Kampaktsis, Damianos G Kokkinidis, Shing-Chiu Wong, Manolis Vavuranakis, Nikolaos J Skubas, Richard B Devereux
Diastolic dysfunction in aortic stenosis results primarily from left ventricular hypertrophy and myocardial fibrosis due to chronically elevated left ventricular systolic pressure. Currently, diastolic dysfunction does not have an explicit clinical role in management of patients with aortic stenosis. Studies have shown that improvement in diastolic dysfunction follows left ventricular remodelling after aortic valve replacement and that it occurs gradually or incompletely. Retrospective studies suggest that advanced grades of diastolic dysfunction at baseline are associated with increased mortality and adverse events even after aortic valve replacement...
July 6, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28599829/noninvasive-coronary-flow-reserve-predicts-response-to-exercise-in-asymptomatic-severe-aortic-stenosis
#11
Patrick Meimoun, Daniel Czitrom, Jérome Clerc, Jean Christophe Seghezzi, Sonia Martis, Alain Berrebi, Frederic Elmkies
BACKGROUND: In patients with asymptomatic aortic stenosis (AS), exercise stress echocardiography (ESE) provides additional prognostic information beyond baseline. The coronary flow velocity reserve (CFVR) is impaired in AS, but its link with exertion is unknown in this setting. The aim of this study was to test the hypothesis that CFVR could predict exercise capacity and abnormal exercise test results in AS. METHODS: Noninvasive CFVR and symptom-limited semisupine ESE were prospectively performed the same day in 43 patients with asymptomatic isolated severe AS (mean age, 68...
August 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28597027/-low-flow-low-gradient-aortic-valve-stenosis-current-evidence
#12
F Tillwich, M A Sherif, S Yücel, A Öner, H Ince
Many patients with severe aortic stenosis have a "low-flow, low-gradient" aortic stenosis. The management of these patients can be quite difficult, as these patients often show impairment of the left ventricle, which can lead to false measurements of the severity of stenosis and also leads to a higher risk during aortic valve replacement. More diagnostic tools than only standard echocardiography are needed to correctly differentiate true severe aortic stenosis from pseudo severe aortic stenosis.
June 9, 2017: Herz
https://www.readbyqxmd.com/read/28587739/aortic-valve-pathology-as-a-predictive-factor-for-acute-aortic-dissection
#13
Denis Berdajs, Selim Mosbahi, Enrico Ferrari, Dominique Charbonnier, Ludwig K von Segesser
BACKGROUND: In this study, the effect of aortic valve (AV) pathology on local hemodynamic conditions was evaluated as a potential trigger for the onset of acute type A and B aortic dissection. METHODS: A time- and pressure-related four-dimensional (4-D) computed fluid dynamic model of the aorta was established. In an experimental setup, AV stenosis and AV insufficiency were created. 4-D pressure-related geometry of the aortic root (AR) with valve insufficiency and valve stenosis were determined by high-fidelity (200 Hz) microsonometric crystals...
June 3, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28552098/cardiopulmonary-exercise-testing-in-aortic-stenosis
#14
Van Doan Tuyet Le
Patients with moderate to severe aortic stenosis (AVA <1.3 cm(2)) who were judged, by a referring cardiologist, as asymptomatic or equivocal symptomatic from the aortic stenosis were included in the study. Patients with left ventricular ejection fraction <50% were not included. Twenty-nine percent of the referred patients were judged asymptomatic and 71% equivocal symptomatic from their valve disease. The mean age was 72 years and 90% of the patients had an AVA-index <0.6 cm(2)/m(2). By clinical evaluation in the outpatient clinic, 48% were judged as having functional limitation corresponding to NYHA≥II...
May 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28543102/low-flow-low-gradient-aortic-stenosis-still-a-diagnostic-and-therapeutic-challenge
#15
REVIEW
Anja Vogelgesang, Gerd Hasenfuss, Claudius Jacobshagen
Aortic stenosis (AS) is the most frequently observed valvular heart disease. During the symptomatic stage, the rate of death increases dramatically, so that a precise diagnostic approach is taken to guide therapeutic options. Of patients with severe AS, 30% to 50% present with low-flow/low-gradient AS (LF/LGAS) status. This review focuses on LF/LGAS and the best diagnostic and therapeutic management in either classic LF/LGAS with reduced left ventricular ejection fraction (LVEF) or paradoxical LF/LGAS with preserved LVEF...
May 23, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28528156/prognostic-impact-of-low-flow-severe-aortic-stenosis-in-small-body-patients-undergoing-tavr-the-ocean-tavi-registry
#16
Akihisa Kataoka, Yusuke Watanabe, Ken Kozuma, Yugo Nara, Fukuko Nagura, Hideyuki Kawashima, Hirofumi Hioki, Makoto Nakashima, Masanori Yamamoto, Kensuke Takagi, Motoharu Araki, Norio Tada, Shinichi Shirai, Futoshi Yamanaka, Kentaro Hayashida
OBJECTIVES: This study aimed to analyze the prognostic impact of low-flow (LF) severe aortic stenosis in small-body patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Western literature demonstrates a poor prognosis with paradoxical LF and low-flow low-gradient (LF-LG) severe aortic stenosis (AS), as defined by stroke volume index (SVi) <35 ml/m(2) and mean pressure gradient <40 mm Hg with preserved left ventricular ejection fraction (LVEF)...
May 11, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28462903/long-term-outcomes-after-tavi-in-patients-with-different-types-of-aortic-stenosis-the-conundrum-of-low-flow-low-gradient-and-low-ejection-fraction
#17
Miriam Puls, Kerstin Pia Korte, Annalen Bleckmann, Mark Huenlich, Bernhard C Danner, Friedrich Schoendube, Gerd Hasenfuß, Claudius Jacobshagen, Wolfgang Schillinger
AIMS: The objective of this study was to examine the impact of guideline-defined subtypes of severe aortic stenosis (AS) on long-term outcomes after TAVI. METHODS AND RESULTS: Four hundred (400) consecutive patients who underwent TAVI (203 transapical, 197 transfemoral) at our institution 8/2008-3/2013 were followed systematically (for up to seven years). One hundred and forty-seven (147) individuals suffered from NEF-HG AS (LV-EF ≥50%, high Pmean ≥40 mmHg), 63 from LEF-HG AS (LV-EF <50%, high gradient), 77 from PLF-LG AS (LV-EF ≥50%, low gradient, stroke volume index [SVI] <35 ml/m²), and 81 from LEF-LG AS (LV-EF <50%, low gradient)...
June 20, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28449976/erratum-to-diagnosis-of-paradoxical-low-flow-low-gradient-aortic-stenosis-a-complex-process-arch-cardiovasc-dis-2017-135-8
#18
Christophe Tribouilloy, Dan Rusinaru
No abstract text is available yet for this article.
April 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28444455/prevalence-predictors-and-prognostic-implications-of-residual-impairment-of-functional-capacity-after-transcatheter-aortic-valve-implantation
#19
Mohammad Abdelghani, Rafael Cavalcante, Yosuke Miyazaki, Robbert J de Winter, Rogério Sarmento-Leite, José A Mangione, Alexandre Abizaid, Pedro A Lemos, Patrick W Serruys, Fabio S de Brito
BACKGROUND: Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement. We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI. METHODS AND RESULTS: Out of 790 patients undergoing TAVI with impaired functional capacity (NYHA II-IV) at baseline, NYHA functional class improved in 592 (86...
April 25, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28431738/aortic-valve-replacement-in-low-flow-low-gradient-aortic-stenosis-left-ventricular-ejection-fraction-matters
#20
EDITORIAL
Victor Dayan, Philippe Pibarot
No abstract text is available yet for this article.
August 2017: Journal of Thoracic and Cardiovascular Surgery
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