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low flow low gradient aortic stenosis

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https://www.readbyqxmd.com/read/28345156/evolving-new-concepts-in-the-assessment-of-aortic-stenosis
#1
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
#2
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%)...
March 20, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
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
#3
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
#4
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
#5
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/28167498/myocardial-oxygen-consumption-and-efficiency-in-aortic-valve-stenosis-patients-with-and-without-heart-failure
#6
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
#7
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
#8
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
#9
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
#10
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/27875347/severe-low-gradient-aortic-stenosis-with-preserved-ventricular-function-should-it-be-treated
#11
REVIEW
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...
January 2017: Journal of Cardiovascular Medicine
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/27739170/trans-catheter-aortic-valve-implantation-with-the-direct-flow-medical-prosthesis-single-center-short-term-clinical-and-echocardiographic-outcomes
#15
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...
February 15, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/27730780/dobutamine-stress-echocardiography-need-for-a-better-gold-standard
#16
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
#17
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
#18
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/27568118/the-functional-significance-of-paradoxical%C3%A2-low-gradient-aortic%C3%A2-valve%C3%A2-stenosis-hemodynamic-findings-during-cardiopulmonary%C3%A2-exercise%C3%A2-testing
#19
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...
January 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27562052/can-severity-of-aortic-stenosis-be-determined-despite-absent-contractile-reserve-in-low-flow-low-gradient-aortic-stenosis
#20
Anastasia Vamvakidou, Benoy N 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.
October 2016: Echocardiography
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