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low flow low gradient aortic stenosis

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https://www.readbyqxmd.com/read/28543102/low-flow-low-gradient-aortic-stenosis-still-a-diagnostic-and-therapeutic-challenge
#1
REVIEW
Anja Vogelgesang, Gerd Hasenfuss, Claudius Jacobshagen
Aortic stenosis (AS) is the most frequently observed valvular heart disease. During the symptomatic stage, the rate of death increases dramatically, so that a precise diagnostic approach is taken to guide therapeutic options. Of patients with severe AS, 30% to 50% present with low-flow/low-gradient AS (LF/LGAS) status. This review focuses on LF/LGAS and the best diagnostic and therapeutic management in either classic LF/LGAS with reduced left ventricular ejection fraction (LVEF) or paradoxical LF/LGAS with preserved LVEF...
May 23, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28528156/prognostic-impact-of-low-flow-severe-aortic-stenosis-in-small-body-patients-undergoing-tavr-the-ocean-tavi-registry
#2
Akihisa Kataoka, Yusuke Watanabe, Ken Kozuma, Yugo Nara, Fukuko Nagura, Hideyuki Kawashima, Hirofumi Hioki, Makoto Nakashima, Masanori Yamamoto, Kensuke Takagi, Motoharu Araki, Norio Tada, Shinichi Shirai, Futoshi Yamanaka, Kentaro Hayashida
OBJECTIVES: This study aimed to analyze the prognostic impact of low-flow (LF) severe aortic stenosis in small-body patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND: Western literature demonstrates a poor prognosis with paradoxical LF and low-flow low-gradient (LF-LG) severe aortic stenosis (AS), as defined by stroke volume index (SVi) <35 ml/m(2) and mean pressure gradient <40 mm Hg with preserved left ventricular ejection fraction (LVEF)...
May 11, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28462903/long-term-outcomes-after-tavi-in-patients-with-different-types-of-aortic-stenosis-the-conundrum-of-low-flow-low-gradient-and-low-ejection-fraction
#3
Miriam Puls, Kerstin Pia Korte, Annalen Bleckmann, Mark Huenlich, Bernhard C Danner, Friedrich Schoendube, Gerd Hasenfuß, Claudius Jacobshagen, Wolfgang Schillinger
AIMS: We examined the impact of guidelines-defined subtypes of severe aortic stenosis (AS) on long-term outcomes after TAVI. METHODS AND RESULTS: 400 consecutive patients who underwent TAVI (203 transapical, 197 transfemoral) at our institution 8/2008-3/2013 were followed systematically (up to 7 years). 147 individuals suffered from NEF-HG AS (LV-EF ≥50%, high Pmean ≥40mmHg), 63 from LEF-HG AS (LV-EF <50%, high gradient), 77 from PLF-LG AS (LV-EF ≥50%, low gradient, stroke volume index (SVI) <35 ml/m²), and 81 from LEF-LG AS (LV-EF <50%, low gradient)...
May 2, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28449976/erratum-to-diagnosis-of-paradoxical-low-flow-low-gradient-aortic-stenosis-a-complex-process-arch-cardiovasc-dis-2017-135-8
#4
Christophe Tribouilloy, Dan Rusinaru
No abstract text is available yet for this article.
April 2017: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/28444455/prevalence-predictors-and-prognostic-implications-of-residual-impairment-of-functional-capacity-after-transcatheter-aortic-valve-implantation
#5
Mohammad Abdelghani, Rafael Cavalcante, Yosuke Miyazaki, Robbert J de Winter, Rogério Sarmento-Leite, José A Mangione, Alexandre Abizaid, Pedro A Lemos, Patrick W Serruys, Fabio S de Brito
BACKGROUND: Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement. We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI. METHODS AND RESULTS: Out of 790 patients undergoing TAVI with impaired functional capacity (NYHA II-IV) at baseline, NYHA functional class improved in 592 (86...
April 25, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28431738/aortic-valve-replacement-in-low-flow-low-gradient-aortic-stenosis-left-ventricular-ejection-fraction-matters
#6
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
#7
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
#8
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
#9
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...
June 1, 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
#10
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/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
#11
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
#12
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...
May 2017: Echocardiography
https://www.readbyqxmd.com/read/28336114/paradoxical-aortic-stenosis-a-systematic-review
#13
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/28292302/impact-of-left-ventricular-outflow-tract-ellipticity-on-the-grading-of-aortic-stenosis-in-patients-with-normal-ejection-fraction
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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