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low flow low gradient aortic stenosis

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
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
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
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
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
Candelas Pérez Del Villar, Raquel Yotti, María Ángeles Espinosa, Enrique Gutiérrez-Ibañes, Alicia Barrio, María José Lorenzo, Pedro Luis Sánchez Fernández, Yolanda Benito, Raquel Prieto, Esther Pérez David, Pablo Martínez-Legazpi, Francisco Fernández-Avilés, Javier Bermejo
OBJECTIVES: The goal of this study was to determine the functional impact of paradoxical low-gradient aortic stenosis (PLGAS) and clarify whether the relevance of the valvular obstruction is related to baseline flow. BACKGROUND: Establishing the significance of PLGAS is particularly challenging. METHODS: Twenty symptomatic patients (77 ± 6 years of age; 17 female subjects) with PLGAS (mean gradient 28 ± 6 mm Hg; aortic valve area 0.8 ± 0...
August 20, 2016: JACC. Cardiovascular Imaging
Anastasia Vamvakidou, Benoy Shah, Roxy Senior
A 79-year-old man presented with increasing breathlessness and his echocardiogram revealed severe left ventricular systolic dysfunction and low-flow low-gradient aortic stenosis. Low-dose dobutamine stress echocardiography revealed the absence of contractile reserve (increase of stroke volume by ≥20% did not occur). The test would have therefore been inconclusive. However, the attainment of normal flow (FR≥200 mL/s) during dobutamine stress enabled the diagnosis of true severe aortic stenosis.
August 25, 2016: Echocardiography
Chirag Bavishi, Kiruthika Balasundaram, Edgar Argulian
OBJECTIVES: This study was designed to evaluate the evidence base for the 2014 American Heart Association/American College of Cardiology (AHA/ACC) guidelines for severe aortic stenosis (SAS) and preserved left ventricular ejection fraction by comparing the natural history of the disease in subgroups of low-gradient (LG) aortic stenosis patients with high-gradient (HG) patients. BACKGROUND: The 2014 AHA/ACC valvular disease guidelines recommend estimation of stroke volume index by echocardiography in patients with suspected LG SAS and preserved left ventricular ejection fraction...
August 11, 2016: JACC. Cardiovascular Imaging
Yong-Qiang Benjamin Tan, Jinghao Nicholas Ngiam, William K F Kong, Tiong-Cheng Yeo, Kian-Keong Poh
BACKGROUND/OBJECTIVES: Paradoxical low-flow aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) has only been described in severe AS. Controversy surrounds prognosis and management but no studies have reported this phenomenon in mild or moderate AS. We investigated the prevalence of flow and gradient patterns in this population, characterising their clinical and echocardiographic profile. METHODS: Consecutive subjects (n=1362) with isolated AS: mild (n=462, aortic valve area≥1...
October 15, 2016: International Journal of Cardiology
Venkatesh Y Anjan, Howard C Herrmann, Philippe Pibarot, William J Stewart, Samir Kapadia, E Murat Tuzcu, Vasilis Babaliaros, Vinod H Thourani, Wilson Y Szeto, Joseph E Bavaria, Susheel Kodali, Rebecca T Hahn, Mathew Williams, D Craig Miller, Pamela S Douglas, Martin B Leon
IMPORTANCE: Low-flow (LF) severe aortic stenosis (AS) is an independent predictor of mortality in patients undergoing aortic valve replacement (AVR). Little is known about improvement in flow after AVR and its effects on survival. OBJECTIVE: To determine whether higher flow (left-ventricular stroke volume index [LVSVI]) after transcatheter AVR (TAVR) would indicate better clinical outcomes in this at-risk population. DESIGN, SETTING, AND PARTICIPANTS: A substudy analysis of data from the Placement of Aortic Transcatheter Valves (PARTNER) randomized clinical trial and continued-access registry was conducted...
August 1, 2016: JAMA Cardiology
Lars Søndergaard, Daniel Andreas Steinbrüchel, Nikolaj Ihlemann, Henrik Nissen, Bo Juel Kjeldsen, Petur Petursson, Anh Thuc Ngo, Niels Thue Olsen, Yanping Chang, Olaf Walter Franzen, Thomas Engstrøm, Peter Clemmensen, Peter Skov Olsen, Hans Gustav Hørsted Thyregod
BACKGROUND: The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize all-comers with severe native aortic valve stenosis to either transcatheter aortic valve replacement (TAVR) with the CoreValve self-expanding bioprosthesis or surgical aortic valve replacement (SAVR), including a lower-risk patient population than previous trials. This article reports 2-year clinical and echocardiographic outcomes from the NOTION trial. METHODS AND RESULTS: Two-hundred eighty patients from 3 centers in Denmark and Sweden were randomized to either TAVR (n=145) or SAVR (n=135) with follow-up planned for 5 years...
June 2016: Circulation. Cardiovascular Interventions
Marie-Annick Clavel, Julien Magne, Philippe Pibarot
An important proportion of patients with aortic stenosis (AS) have a 'low-gradient' AS, i.e. a small aortic valve area (AVA <1.0 cm(2)) consistent with severe AS but a low mean transvalvular gradient (<40 mmHg) consistent with non-severe AS. The management of this subset of patients is particularly challenging because the AVA-gradient discrepancy raises uncertainty about the actual stenosis severity and thus about the indication for aortic valve replacement (AVR) if the patient has symptoms and/or left ventricular (LV) systolic dysfunction...
September 7, 2016: European Heart Journal
Romain Capoulade, Florent Le Ven, Marie-Annick Clavel, Jean G Dumesnil, Abdellaziz Dahou, Christophe Thébault, Marie Arsenault, Kim O'Connor, Élisabeth Bédard, Jonathan Beaudoin, Mario Sénéchal, Mathieu Bernier, Philippe Pibarot
OBJECTIVE: The study purpose was to assess the usefulness of echocardiographic parameters of aortic stenosis (AS) severity and left ventricular (LV) systolic function to predict mortality in AS. The main hypothesis is that parameters of LV systolic function are the most important independent predictors of mortality, whereas parameters of stenosis severity are not. METHODS: 1065 consecutive patients with AS referred to the echocardiography laboratory and meeting the inclusion/exclusion criteria were included and followed during 5...
June 15, 2016: Heart: Official Journal of the British Cardiac Society
Nishath Quader, Brian R Lindman
No abstract text is available yet for this article.
April 2016: Journal of the American Society of Echocardiography
Jose F Condado, Peter C Block
Patients with paradoxical low flow low gradient (PLFLG) aortic stenosis (AS) have favorable mid-term outcomes after transcatheter aortic valve replacement (TAVR). These outcomes were comparable to those patients with high gradient AS (HGAS). Clinicians should avoid delaying referral of patients with PLFLG AS for valve replacement for either surgical aortic valve replacement (SAVR) or TAVR. Further studies are need to understand the increased early mortality after TAVR in PLFLG AS compared to HGAS, and to determine whether improvements of TAVR procedural techniques can result in better outcomes...
March 2016: Catheterization and Cardiovascular Interventions
Guy Witberg, Alon Barsheshet, Abid Assali, Hana Vaknin-Assa, Aviv A Shaul, Katia Orvin, Moti Vaturi, Shmuel Schwartzenberg, Yaron Shapira, Alexander Sagie, Ran Kornowski
OBJECTIVES: To explore the relation between the baseline aortic valve gradient (AVG) as a continuous variable and clinical outcomes following transcatheter aortic valve implantation (TAVI) in general and specifically in patients with high-gradient aortic stenosis (AS). METHODS: We reviewed 317 consecutive patients who underwent TAVI at our institution. We investigated the relation between AVG as a continuous/categorical variable and outcome among all patients and in patients without low-flow low-gradient AS, using the Cox proportional hazard model adjusting for multiple prognostic variables...
2016: Cardiology
Abhishek Chaturvedi, Susan K Hobbs, Fred S Ling, Apeksha Chaturvedi, Peter Knight
Transcatheter Aortic Valve Implantation (TAVI) is increasingly being used in patients with severe aortic stenosis who are not candidates for surgery. ECG-gated CT angiography (CTA) plays an important role in the preoperative planning for these devices. As the number of patients undergoing these procedures increases, a subset of patients is being recognized who have contraindications to iodinated contrast medium, either due to a prior severe allergic type reaction or poor renal function. Another subgroup of patients with low flow and low gradient aortic stenosis is being recognized that are usually assessed for severity of aortic stenosis by stress echocardiography...
April 2016: Insights Into Imaging
Arnault Galat, Aziz Guellich, Diane Bodez, Michel Slama, Marina Dijos, David Messika Zeitoun, Olivier Milleron, David Attias, Jean-Luc Dubois-Randé, Dania Mohty, Etienne Audureau, Emmanuel Teiger, Jean Rosso, Jean-Luc Monin, Thibaud Damy
BACKGROUND: Aortic stenosis (AS) and transthyretin cardiac amyloidosis (TTR-CA) are both frequent in elderly. The combination of these two diseases has never been investigated. AIMS: To describe patients with concomitant AS and TTR-CA. METHODS: Six cardiologic French centres identified retrospectively cases of patients with severe or moderate AS associated with TTR-CA hospitalized during the last 6 years. RESULTS: Sixteen patients were included...
February 22, 2016: European Heart Journal
Shoko Doi, Yohei Ohno, Gaku Nakazawa, Yuji Ikari
No abstract text is available yet for this article.
September 7, 2016: European Heart Journal
H Ten Freyhaus, S Baldus
In approximately one third of patients presenting with suspected severe aortic stenosis, there is a discrepancy between a severely reduced aortic valve opening area (< 1 cm(2)) and a non-severe increase of the mean transvalvular gradient (< 40 mmHg). In a substantial number of these cases there is evidence of a severe paradoxical low-flow low-gradient aortic stenosis, characterized by a reduced stroke volume index in the setting of a normal left ventricular ejection fraction. This finding should trigger an extensive diagnostic work-up, including echocardiography, stress echocardiography and computed tomography to rule out measurement errors and to identify the cause(s) of the hemodynamic discrepancy...
April 2016: Der Internist
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