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low flow low gradient aortic stenosis

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https://www.readbyqxmd.com/read/27875347/severe-low-gradient-aortic-stenosis-with-preserved-ventricular-function-should-it-be-treated
#1
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/27792660/delayed-time-to-peak-velocity-is-useful-for-detecting-severe-aortic-stenosis
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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-exercise%C3%A2-testing
#9
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
https://www.readbyqxmd.com/read/27562052/can-severity-of-aortic-stenosis-be-determined-despite-absent-contractile-reserve-in-low-flow-low-gradient-aortic-stenosis
#10
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
https://www.readbyqxmd.com/read/27544900/integration-of-flow-gradient-patterns-into%C3%A2-clinical-decision-making-for-patients-with-suspected-severe-aortic-stenosis-and-preserved-lvef-a-systematic-review-of-evidence-and-meta-analysis
#11
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...
November 2016: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/27458659/prevalence-clinical-and-echocardiographic-characteristics-of-various-flow-and-gradient-patterns-in-mild-or-moderate-aortic-stenosis-with-normal-left-ventricular-ejection-fraction
#12
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
https://www.readbyqxmd.com/read/27437665/evaluation-of-flow-after-transcatheter-aortic-valve-replacement-in-patients-with-low-flow-aortic-stenosis-a-secondary-analysis-of-the-partner-randomized-clinical-trial
#13
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
https://www.readbyqxmd.com/read/27296202/two-year-outcomes-in-patients-with-severe-aortic-valve-stenosis-randomized-to-transcatheter-versus-surgical-aortic-valve-replacement-the-all-comers-nordic-aortic-valve-intervention-randomized-clinical-trial
#14
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
https://www.readbyqxmd.com/read/27190103/low-gradient-aortic-stenosis
#15
REVIEW
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
https://www.readbyqxmd.com/read/27048774/echocardiographic-predictors-of-outcomes-in-adults-with-aortic-stenosis
#16
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
https://www.readbyqxmd.com/read/27037984/shifting-the-spotlight-onto-the-forgotten-ventricle-role-of-the-right-ventricle-in-low-flow-low-gradient-aortic-stenosis
#17
EDITORIAL
Nishath Quader, Brian R Lindman
No abstract text is available yet for this article.
April 2016: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/26994985/is-it-really-paradoxical-or-just-the-ventricle
#18
EDITORIAL
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
https://www.readbyqxmd.com/read/26953820/aortic-valve-gradient-and-clinical-outcome-in-patients-undergoing-transcatheter-aortic-valve-implantation-for-severe-aortic-stenosis
#19
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
https://www.readbyqxmd.com/read/26911969/mri-evaluation-prior-to-transcatheter-aortic-valve-implantation-tavi-when-to-acquire-and-how-to-interpret
#20
REVIEW
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
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