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Low flow aortic stenosis

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https://www.readbyqxmd.com/read/28183438/cardiac-imaging-for-assessing-low-gradient-severe-aortic-stenosis
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/27887818/three-dimensional-morphology-of-the-left-ventricular-outflow-tract-impact-on-grading-aortic-stenosis-severity
#9
Luis Caballero, Daniel Saura, María José Oliva-Sandoval, Josefa González-Carrillo, María Dolores Espinosa, Miguel García-Navarro, Mariano Valdés, Patrizio Lancellotti, Gonzalo de la Morena
BACKGROUND: Left ventricular outflow tract (LVOT) measurement is a critical step in the quantification of aortic valve area. The assumption of a circular morphology of the LVOT may induce some errors. The aim of this study was to assess the three-dimensional (3D) morphology of the LVOT and its impact on grading aortic stenosis severity. METHODS: Fifty-eight patients with aortic stenosis were studied retrospectively. LVOT dimensions were measured using 3D transesophageal echocardiography at three levels: at the hinge points (HP) of the aortic valve and at 4 and 8 mm proximal to the annular plane...
January 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/27875347/severe-low-gradient-aortic-stenosis-with-preserved-ventricular-function-should-it-be-treated
#10
Giuseppe Di Pasquale, Gloria Vassilikì Coutsoumbas, Silvia Zagnoni
Exists a group of patients with small AVA (<0,6 cm/m), and normal LVEF (≥50%) who display a low transvalvular flow (LF) [index stroke volume (SVi)<35 ml/m2] and/or low transvalvular gradient (LG). This condition is called severe paradoxical aortic stenosis (SAO) LFLG. In many studies this condition was associated to increased mortality both with medical therapy and with surgical intervention. Crucial is define correctly the diagnostical criteria of this condition. Indeed there are several specific anatomical and functional characteristics useful in differentiating paradoxical severe aortic stenosis from the other forms of aortic stenosis...
November 19, 2016: Journal of Cardiovascular Medicine
https://www.readbyqxmd.com/read/27795630/high-hemodialysis-vascular-access-flow-and-impaired-right-ventricular-function-in-chronic-hemodialysis-patients
#11
S Yilmaz, M Yetim, B K Yilmaz, T Dogan, E Aksoy, N Yuksel, I Dogan
There are limited data showing right ventricular preload increase due to high-flow arteriovenous fistulas (AVFs). This cross-sectional study investigated whether high AVF flow had an impact on right ventricular function in patients undergoing hemodialysis. Sixty-four patients aged between 18 and 85 years who were on routine hemodialysis with >2 hemodialysis sessions per week for at least 3 months via an AVF were studied. Patients with inadequate flow fistulas, severe chronic obstructive pulmonary disease, history of pulmonary embolism, primary pulmonary hypertension, severe mitral, aortic or pulmonary regurgitation, and/or stenosis were excluded...
September 2016: Indian Journal of Nephrology
https://www.readbyqxmd.com/read/27792660/delayed-time-to-peak-velocity-is-useful-for-detecting-severe-aortic-stenosis
#12
Daisuke Kamimura, Sartaj Hans, Takeki Suzuki, Ervin R Fox, Michael E Hall, Solomon K Musani, Michael R McMullan, William C Little
BACKGROUND: Time to peak velocity (TPV) is an echocardiographic variable that can be easily measured and reflects a late peaking murmur, a classic physical finding suggesting severe aortic stenosis (AS). The aim of this study was to investigate the usefulness of TPV to evaluate AS severity. METHODS AND RESULTS: This study included 700 AS patients, whose aortic valve area (AVA) was <1.5 cm(2), and 200 control patients. The TPV was defined as the time from aortic valve opening to when the flow velocity across the aortic valve reaches its peak...
October 22, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27792655/relationship-between-qt-interval-and-outcome-in-low-flow-low-gradient-aortic-stenosis-with-low-left-ventricular-ejection-fraction
#13
Abdellaziz Dahou, Oumhani Toubal, Marie-Annick Clavel, Jonathan Beaudoin, Julien Magne, Patrick Mathieu, François Philippon, Jean G Dumesnil, Rishi Puri, Henrique B Ribeiro, Éric Larose, Josep Rodés-Cabau, Philippe Pibarot
BACKGROUND: QT interval has been shown to be associated with cardiovascular events. There is no data regarding the association between QT interval and left ventricular (LV) function and prognosis in patients with low LV ejection fraction (LVEF), low-flow, low-gradient aortic stenosis (LF-LG AS). We aimed to examine the relationship between corrected QT interval (QTc) and LV function and outcome in these patients. METHODS AND RESULTS: Ninety-three patients (73±10 years; 74% men) with LF-LG AS (mean gradient <40 mm Hg and indexed aortic valve area ≤0...
October 20, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27753861/br-02-1-management-of-hypertension-in-severe-aortic-stenosis
#14
Yong-Jin Kim
Aortic stenosis (AS) is a common valve disease, affecting nearly 5% of elderly individuals. Because most common etiology of AS is degenerative valve disease, hypertension (HT) is not rare in patients with AS. It was reported that more than 30% of patients with AS had systemic hypertension. Therefore, management of hypertension is an important issue for these patients. There are several effects of combined AS and HT. First, HT increases hemodynamic load of left ventricle and peak systolic left ventricular wall stress...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27741366/diverse-outcome-following-early-prenatal-diagnosis-of-pulmonary-stenosis
#15
M Bronshtein, Z Blumenfeld, A Khoury, A Gover
OBJECTIVE: To assess the natural history and outcome of fetal pulmonary stenosis (PS), particularly that detected at 14-17 weeks' gestation. METHODS: In this retrospective study we searched an electronic database of women from the general Israeli population attending a private ultrasound institute (Al-Kol ultrasound institute in Haifa) for routine complete early fetal ultrasound, including all fetal systems and a fetal echocardiogram, between 2004 and 2015. Ninety-seven percent of the women were at low risk of fetal malformations, and 3% had risk factors such as maternal Type-1 diabetes mellitus, exposure during pregnancy to teratogenic drugs, or anomalies in previous pregnancies or in other family members...
February 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27739170/trans-catheter-aortic-valve-implantation-with-the-direct-flow-medical-prosthesis-single-center-short-term-clinical-and-echocardiographic-outcomes
#16
Stephan Kische, Giuseppe D'Ancona, Hüseyin U Agma, Gihan El-Achkar, Martin Dißmann, Jasmin Ortak, Hüseyin Ince
OBJECTIVES: To analyze our single center experience with the Direct Flow Medical (DFM). BACKGROUND: The DFM has been recently introduced to the market and large real world experiences are lacking. METHODS: A total of 126 patients with severe aortic valve stenosis (AVS) were treated by the same team from March 2013 to May 2015. Device success and procedural safety were classified, according to valve academic research consortium (VARC) criteria, for the entire cohort, including patients treated in the early phases of our learning curve...
October 14, 2016: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27730780/dobutamine-stress-echocardiography-need-for-a-better-gold-standard
#17
Ankush Sachdeva, Biswajit Paul
Dobutamine stress echocardiography (DSE) has come a long way as establishing itself as a feasible, safe, effective, relatively cheaper non-invasive technique to detect population suffering from coronary artery disease (CAD) and following up patients post revascuralization. Besides these DSE is commonly used to diagnose low gradient, low flow true severe aortic stenosis (AS); differentiating it from pseudo- AS and to follow up patients with dilated cardiomyopathy (DCMP). Various non-invasive techniques have different sensitivity and specificity to accurately judge a viable myocardium and to accurately detect the improvement in regional wall motion abnormality (RWMA) post-revascularization, leading to an overall increase in left ventricular ejection fraction (LVEF)...
February 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27643098/br-02-1-management-of-hypertension-in-severe-aortic-stenosis
#18
Yong-Jin Kim
Aortic stenosis (AS) is a common valve disease, affecting nearly 5% of elderly individuals. Because most common etiology of AS is degenerative valve disease, hypertension (HT) is not rare in patients with AS. It was reported that more than 30% of patients with AS had systemic hypertension. Therefore, management of hypertension is an important issue for these patients. There are several effects of combined AS and HT. First, HT increases hemodynamic load of left ventricle and peak systolic left ventricular wall stress...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27629961/an-adult-case-of-unicommissural-unicuspid-aortic-valve-diagnosed-based-on-the-intraoperative-findings
#19
Tetsuo Yamanaka, Toru Fukatsu, Yoshimaro Ichinohe, Hirotaka Komatsu, Masahiro Seki, Kenichi Sasaki, Hideaki Takai, Takashi Kunihara, Yasunobu Hirata
We herein report an adult case of unicommissural unicuspid aortic valve (UAV). A 59-year-old man, who was noted to have a cardiac murmur at 31 years of age, was admitted to our hospital due to acute heart failure. Severe calcification in the aortic valve with severe low-flow/low-gradient aortic stenosis and moderate aortic regurgitation was observed and thought to be the cause of heart failure, however, the etiology of aortic valve dysfunction was not clear. Aortic valve replacement was subsequently performed, and unicommissural UAV was diagnosed according to the intraoperative findings...
2016: Internal Medicine
https://www.readbyqxmd.com/read/27568123/exercise-testing-in-paradoxical-low-flow-aortic-stenosis-where-is-the-truth
#20
EDITORIAL
James D Thomas, Nicholas Furiasse
No abstract text is available yet for this article.
January 2017: JACC. Cardiovascular Imaging
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