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Low flow aortic stenosis

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https://www.readbyqxmd.com/read/28431738/aortic-valve-replacement-in-low-flow-low-gradient-aortic-stenosis-left-ventricular-ejection-fraction-matters
#1
EDITORIAL
Victor Dayan, Philippe Pibarot
No abstract text is available yet for this article.
April 2, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28412115/outcome-of-isolated-aortic-valve-replacement-in-patients-with-classic-and-paradoxical-low-flow-low-gradient-aortic-stenosis
#2
Ana Lopez-Marco, Harriet Miller, Pankaj Kumar, Saeed Ashraf, Afzal Zaidi, Farah Bhatti, Adrian Ionescu, Aprim Youhana
OBJECTIVE: To analyze operative outcomes and mid-term results after isolated aortic valve replacement (AVR) in low-flow, low-gradient aortic stenosis (LFLG AS) by comparing the 2 subcategories (classic low-flow, low-gradient aortic stenosis [CLFLG] and paradoxical low-flow, low-gradient aortic stenosis [PLFLG]). METHODS: This was a retrospective analysis of prospectively collected data for all isolated AVR in LFLG AS performed in our center during the last 13 years (n = 198; CLFLG AS, n = 66, 33% and PLFLG AS, n = 132, 67%)...
March 12, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28395281/the-role-of-stress-echocardiography-in-valvular-heart-disease-a-current-appraisal
#3
James L Gentry Iii, Dermot Phelan, Milind Y Desai, Brian P Griffin
Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed...
April 11, 2017: Cardiology
https://www.readbyqxmd.com/read/28390678/effect-of-renin-angiotensin-blockers-on-left-ventricular-remodeling-in-severe-aortic-stenosis
#4
Serene Si-Ning Goh, Ching-Hui Sia, Nicholas Jinghao Ngiam, Benjamin Yong-Qiang Tan, Poay Sian Lee, Edgar Lik-Wui Tay, William Kok-Fai Kong, Tiong Cheng Yeo, Kian-Keong Poh
Studies have shown that medical therapy with renin-angiotensin blockers (RABs) may benefit patients with aortic stenosis (AS). However, its use and efficacy remains controversial, including in patients with low flow (LF) with preserved left ventricular ejection fraction (LVEF). We examined the effects of RAB use on LV remodeling in patients with severe AS with preserved LVEF, analyzing the differential effects in patients with LF compared with normal flow (NF). This is a retrospective study of 428 consecutive subjects from 2005 to 2014 with echocardiographic diagnosis of severe AS and preserved LVEF...
March 16, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28385280/recommendations-on-the-echocardiographic-assessment-of-aortic-valve-stenosis-a-focused-update-from-the-european-association-of-cardiovascular-imaging-and-the-american-society-of-echocardiography
#5
Helmut Baumgartner, Judy Hung, Javier Bermejo, John B Chambers, Thor Edvardsen, Steven Goldstein, Patrizio Lancellotti, Melissa LeFevre, Fletcher Miller, Catherine M Otto
Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis. Because clinical decision-making is based on the echocardiographic assessment of its severity, it is essential that standards are adopted to maintain accuracy and consistency across echocardiographic laboratories. Detailed recommendations for the echocardiographic assessment of valve stenosis were published by the European Association of Echocardiography and the American Society of Echocardiography in 2009. In the meantime, numerous new studies on aortic stenosis have been published with particular new insights into the difficult subgroup of low gradient aortic stenosis making an update of recommendations necessary...
April 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28370476/comparing-characteristics-and-clinical-and-echocardiographic-outcomes-in-low-flow-vs-normal-flow-severe-aortic-stenosis-with-preserved-ejection-fraction-in-an-asian-population
#6
Jinghao Nicholas Ngiam, Benjamin Yong-Qiang Tan, Ching-Hui Sia, Glenn K M Lee, William K F Kong, Yiong-Huak Chan, Kian-Keong Poh
BACKGROUND/OBJECTIVES: In severe aortic stenosis (AS), deterioration of left ventricular ejection fraction (LVEF) to <50% is an AHA/ACC class I indication for valve replacement, regardless of symptoms. Controversy surrounds prognosis of low-flow AS compared to normal-flow, and no study has examined LVEF deterioration. We compared factors associated with LVEF deterioration (to <50%) and clinical outcomes. METHODS: Consecutive subjects with low-flow (stroke volume index <35 mL/m(2) , n=56) and normal-flow (n=72) severe AS (aortic valve area <1 cm(2) ) with preserved LVEF (>50%) and with paired echocardiography were studied...
April 1, 2017: Echocardiography
https://www.readbyqxmd.com/read/28363204/recommendations-on-the-echocardiographic-assessment-of-aortic-valve-stenosis-a-focused-update-from-the-european-association-of-cardiovascular-imaging-and-the-american-society-of-echocardiography
#7
Helmut Baumgartner, Judy Hung, Javier Bermejo, John B Chambers, Thor Edvardsen, Steven Goldstein, Patrizio Lancellotti, Melissa LeFevre, Fletcher Miller, Catherine M Otto
Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis. Because clinical decision-making is based on the echocardiographic assessment of its severity, it is essential that standards are adopted to maintain accuracy and consistency across echocardiographic laboratories. Detailed recommendations for the echocardiographic assessment of valve stenosis were published by the European Association of Echocardiography and the American Society of Echocardiography in 2009. In the meantime, numerous new studies on aortic stenosis have been published with particular new insights into the difficult subgroup of low gradient aortic stenosis making an update of recommendations necessary...
March 1, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/28345156/evolving-new-concepts-in-the-assessment-of-aortic-stenosis
#8
REVIEW
Peerawut Deeprasertkul, Masood Ahmad
Echocardiography has been pivotal in evaluating aortic stenosis (AS) over the past several decades. Recent experience has shown a wide spectrum in the clinical presentation of AS. A better understanding of the underlying hemodynamic principles has resulted in emergence of new subtypes of AS. New treatment modalities have also been introduced, requiring precise evaluation of aortic valve (AV) pathology for implementation of these therapies. This review will discuss new concepts and indices in the use of echocardiography in patients with AS...
March 27, 2017: Echocardiography
https://www.readbyqxmd.com/read/28336114/paradoxical-aortic-stenosis-a-systematic-review
#9
Rita Cavaca, Rogério Teixeira, Maria João Vieira, Lino Gonçalves
Aortic stenosis (AS) is a complex systemic valvular and vascular disease with a high prevalence in developed countries. The new entity "paradoxical low-flow, low-gradient aortic stenosis" refers to cases in which patients have severe AS based on assessment of aortic valve area (AVA) (≤1 cm(2)) or indexed AVA (≤0.6 cm(2)/m(2)), but paradoxically have a low mean transvalvular gradient (<40 mmHg) and a low stroke volume index (≤35 ml/m(2)), despite preserved left ventricular ejection fraction (≥50%)...
April 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/28314673/can-we-perform-rotational-atherectomy-in-patients-with-severe-aortic-stenosis-substudy-from-the-ocean-tavi-registry
#10
Toru Naganuma, Hiroyoshi Kawamoto, Kensuke Takagi, Hiroto Yabushita, Satoru Mitomo, Yusuke Watanabe, Shinichi Shirai, Motoharu Araki, Norio Tada, Futoshi Yamanaka, Masanori Yamamoto, Hirokazu Onishi, Sunao Nakamura, Akihiro Higashimori, Minoru Tabata, Kazuki Mizutani, Hiroshi Ueno, Kentaro Hayashida
PURPOSE: The aim of this study was to report the safety of coronary rotational atherectomy (RA) in patients with severe aortic stenosis (AS). RA in the clinical setting seems challenging because coronary slow flow leads to hemodynamic instability. METHODS: Between October 2013 and May 2016, 1401 patients in the Optimized transCathEter vAlvular iNtervention (OCEAN) registry in Japan underwent transcatheter aortic valve implantation (TAVI). The primary study endpoint was procedural success, defined as residual stenosis <20% with final Thrombolysis in Myocardial Infarction flow 3...
February 28, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28292302/impact-of-left-ventricular-outflow-tract-ellipticity-on-the-grading-of-aortic-stenosis-in-patients-with-normal-ejection-fraction
#11
Frédéric Maes, Sophie Pierard, Christophe de Meester, Jamila Boulif, Mihaela Amzulescu, David Vancraeynest, Anne-Catherine Pouleur, Agnès Pasquet, Bernhard Gerber, Jean-Louis Vanoverschelde
BACKGROUND: The pathophysiology of paradoxical low-gradient (LG) severe aortic stenosis (SAS) remains controversial. As low transvalvular flow has been implicated, we sought to investigate the impact of left ventricular outflow tract (LVOT) ellipticity on the estimation of the LV stroke volume, the calculation of the aortic valve area (AVA) by use of the continuity equation and on AS severity grading. METHODS: We studied 190 consecutive patients (mean age: 72 ± 13 years; male: 57%) with SAS (indexed AVA < 0...
March 15, 2017: Journal of Cardiovascular Magnetic Resonance
https://www.readbyqxmd.com/read/28256405/diagnosis-of-paradoxical-low-flow-low-gradient-aortic-stenosis-a-complex-process
#12
EDITORIAL
Christophe Tribouilloy, Dan Rusinaru
No abstract text is available yet for this article.
March 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28183438/cardiac-imaging-for-assessing-low-gradient-severe-aortic-stenosis
#13
REVIEW
Marie-Annick Clavel, Ian G Burwash, Philippe Pibarot
Up to 40% of patients with aortic stenosis (AS) harbor discordant Doppler-echocardiographic findings, the most common of which is the presence of a small aortic valve area (≤1.0 cm(2)) suggesting severe AS, but a low gradient (<40 mm Hg) suggesting nonsevere AS. The purpose of this paper is to present the role of multimodality imaging in the diagnostic and therapeutic management of this challenging entity referred to as low-gradient AS. Doppler-echocardiography is critical to determine the subtype of low-gradient AS: that is, classical low-flow, paradoxical low-flow, or normal-flow...
February 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28169057/invasive-assessment-of-coronary-flow-reserve-impairment-in-severe-aortic-stenosis-and-ecochadiographic-correlations
#14
Alejandro Gutiérrez-Barrios, Sergio Gamaza-Chulián, Antonio Agarrado-Luna, Dolores Ruiz-Fernández, G Calle-Pérez, E Marante-Fuertes, R Zayas-Rueda, Miguel Alba-Sánchez, Jesús Oneto-Otero, R Vázquez-Garcia
OBJECTIVES AND BACKGROUND: Patients with aortic stenosis (AS) may have impaired coronary flow reserve (CFR) despite angiographically normal coronary arteries. This is the first report of invasive thermodilution-derived CFR and IMR in patients with AS and their associations with echocardiographic parameters for AS assessment. METHODS: Thirty-six consecutive severe AS patients and ten patients without AS underwent prospectively cardiac catheterization and coronary physiological parameters were determined in the left anterior descending (LAD)...
February 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28167498/myocardial-oxygen-consumption-and-efficiency-in-aortic-valve-stenosis-patients-with-and-without-heart-failure
#15
Nils Henrik Stubkjær Hansson, Jens Sörensen, Hendrik Johannes Harms, Won Yong Kim, Roni Nielsen, Lars P Tolbod, Jørgen Frøkiær, Kirsten Bouchelouche, Karen Kaae Dodt, Inger Sihm, Steen Hvitfeldt Poulsen, Henrik Wiggers
BACKGROUND: Myocardial oxygen consumption (MVO2) and its coupling to contractile work are fundamentals of cardiac function and may be involved causally in the transition from compensated left ventricular hypertrophy to failure. Nevertheless, these processes have not been studied previously in patients with aortic valve stenosis (AS). METHODS AND RESULTS: Participants underwent (11)C-acetate positron emission tomography, cardiovascular magnetic resonance, and echocardiography to measure MVO2 and myocardial external efficiency (MEE) defined as the ratio of left ventricular stroke work and the energy equivalent of MVO2...
February 6, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28154595/role-of-transesophageal-echocardiography-in-the-diagnosis-of-paradoxical-low-flow-low-gradient-severe-aortic-stenosis
#16
Muaz M Abudiab, Anil Pandit, Hari P Chaliki
BACKGROUND AND OBJECTIVES: Prior studies indicate that up to 35% of cases of severe aortic stenosis (AS) have paradoxical low flow, low gradient despite preserved left ventricular ejection fraction (LVEF). However, error in left ventricular outflow tract (LVOT) diameter may lead to misclassification. Herein, we determined whether measurement of LVOT diameter by transesophageal echocardiography (TEE) results in reclassification of cases to non-severe AS. SUBJECTS AND METHODS: Patients with severe AS with aortic valve area (AVA) <1 cm(2) by transthoracic echocardiography (TTE) within 6 months were studied...
January 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28154585/paradoxical-low-flow-low-gradient-aortic-stenosis-a-tough-nut-to-crack-in-echocardiographic-diagnosis
#17
EDITORIAL
Mi-Jeong Kim
No abstract text is available yet for this article.
January 2017: Korean Circulation Journal
https://www.readbyqxmd.com/read/28005568/dilemma-in-the-therapeutic-management-of-low-gradient-aortic-stenosis
#18
Marie-Annick Clavel, Nancy Côté, Philippe Pibarot
PURPOSE OF REVIEW: Grading of aortic stenosis is essential in aortic stenosis management patients. However, despite clear thresholds provided in the guidelines, up to 30% of patients have discordant grading of aortic stenosis. The management of patients with low gradients/velocity despite tight aortic valve area is challenging. RECENT FINDINGS: Recent studies demonstrated that patients with or without low flow may have a severe aortic stenosis despite a low gradient...
March 2017: Current Opinion in Cardiology
https://www.readbyqxmd.com/read/27989054/contribution-of-dobutamine-stress-echocardiography-to-the-diagnosis-and-prognosis-of-low-flow-low-gradient-aortic-stenosis
#19
Sílvia Aguiar Rosa, Luísa Moura Branco, Ana Galrinho, Guilherme Portugal, Joäo Abreu, Duarte Cacela, José Fragata, Rui Cruz Ferreira
BACKGROUND: Aortic valve replacement (AVR) is the treatment of choice in patients with severe symptomatic aortic stenosis (AS). Patients with a low left ventricular ejection fraction (LVEF) represent a challenge for evaluation and therapeutic decision. Dobutamine stress echocardiography (DSE) allows the distinction to be made between fixed low-flow/low-gradient (LF/LG) AS and pseudosevere AS. METHODS: Between 2001 and 2014 a retrospective analysis was conducted of patients who underwent DSE to investigate severe AS...
March 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/27934611/a-multicentre-european-registry-to-evaluate-the-direct-flow-medical-transcatheter-aortic-valve-system-for-the-treatment-of-patients-with-severe-aortic-stenosis
#20
Christoph K Naber, Stylianos A Pyxaras, Hüseyin Ince, Peter Frambach, Antonio Colombo, Christian Butter, Fernando Gatto, Ulrich Hink, Georg Nickenig, Giuseppe Bruschi, Guus Brueren, Didier Tchétché, Peter Den Heijer, Wolfgang Schillinger, Smita Scholtz, Jan Van der Heyden, Thierry Lefèvre, Martine Gilard, Karl-Heinz Kuck, Joachim Schofer, Dimitar Divchev, Helmut Baumgartner, Federico Asch, Daniel Wagner, Azeem Latib, Federico De Marco, Stephan Kische
AIMS: Our aim was to assess the clinical outcomes of the Direct Flow Medical Transcatheter Aortic Valve System (DFM-TAVS), when used in routine clinical practice. METHODS AND RESULTS: This is a prospective, open-label, multicentre, post-market registry of patients treated with DFM-TAVS according to approved commercial indications. Echocardiographic and angiographic data were evaluated by an independent core laboratory and adverse events were adjudicated and classified according to VARC-2 criteria by an independent clinical events committee...
December 10, 2016: EuroIntervention
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