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low flow low gradient aortic stenosis

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https://www.readbyqxmd.com/read/29762932/pulmonary-hypertension-as-a-possible-cause-of-paradoxical-low-flow-low-gradient-aortic-stenosis
#1
Yuta Watanabe, Haruhiko Higashi, Katsuji Inoue, Jun Aono, Takafumi Okura, Jitsuo Higaki, Shuntaro Ikeda
Paradoxical low-flow, low-gradient aortic stenosis (LFLG AS) is recognized as a subtype of aortic stenosis. A small left ventricular (LV) cavity with marked LV concentric remodeling leads to a reduced stroke volume in this condition. The case is reported of a paradoxical LFLG AS patient who was undergoing treatment for pulmonary hypertension (PH) and interstitial pneumonia associated with scleroderma. Echocardiography demonstrated enlargement of the right ventricle and a diminished LV cavity. Moreover, the aortic valve opening was restricted despite a preserved LV ejection fraction (61%)...
September 2017: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/29721704/workup-and-management-of-patients-with-paradoxical-low-flow-low-gradient-aortic-stenosis
#2
REVIEW
Mohamed-Salah Annabi, Marine Clisson, Marie-Annick Clavel, Philippe Pibarot
About 60% of patients with paradoxical low-flow, low-gradient (PLF-LG) aortic stenosis (AS) have a severe disease that justifies aortic valve replacement (AVR). The first step in patients with symptomatic PLF AS should be to rule out measurement errors and treat hypertension. The second step is to distinguish pseudo-severe from true severe AS (TSAS). The third step is to select the optimal treatment modality at the right time. Regarding the second step, projected aortic valve area calculated using stress echocardiography is superior to traditional severity criteria (AVA < 1...
May 2, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29698407/a-novel-echocardiographic-hemodynamic-index-for-predicting-outcome-of-aortic-stenosis-patients-following-transcatheter-aortic-valve-replacement
#3
Altayyeb Yousef, Benjamin Hibbert, Joshua Feder, Jordan Bernick, Juan Russo, Zachary MacDonald, Christopher Glover, Alexander Dick, Munir Boodhwani, Buu-Khanh Lam, Marc Ruel, Marino Labinaz, Ian G Burwash
OBJECTIVE: Transcatheter aortic valve replacement (TAVR) reduces left ventricular (LV) afterload and improves prognosis in aortic stenosis (AS) patients. However, LV afterload consists of both valvular and arterial loads, and the benefits of TAVR may be attenuated if the arterial load dominates. We proposed a new hemodynamic index, the Relative Valve Load (RVL), a ratio of mean gradient (MG) and valvuloarterial impedance (Zva), to describe the relative contribution of the valvular load to the global LV load, and examined whether RVL predicted patient outcome following TAVR...
2018: PloS One
https://www.readbyqxmd.com/read/29622096/management-of-patients-with-aortic-valve-stenosis
#4
REVIEW
Amrit Kanwar, Jeremy J Thaden, Vuyisile T Nkomo
With increased life expectancy and aging of the population, aortic stenosis is now one of the most common valvular heart diseases. Early recognition and management of aortic stenosis are of paramount importance because untreated symptomatic severe disease is universally fatal. The advent of transcather aortic valve replacement technologies provides exciting avenues of care to patients with this disease in whom traditional surgical procedures could not be performed or were associated with high risk. This review for clinicians offers an overview of aortic stenosis and updated information on the current status of various treatment strategies...
April 2018: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/29572249/take-home-messages-with-cases-from-focused-update-on-echocardiographic-assessment-of-aortic-stenosis
#5
REVIEW
Judy Hung, Sheila Liu Klassen, Javier Bermejo, John Boyd Chambers
Echocardiography plays an important role in the assessment of valvular aortic stenosis. Updated recommendations focusing on a stepwise approach to evaluating aortic stenosis have recently been published by the European Association of Cardiovascular Imaging and the American Society of Echocardiography. This review uses illustrative cases to demonstrate technical aspects of aortic stenosis assessment and use of the new proposed classification scheme for aortic stenosis. Key points from the updated recommendations reviewed in this paper are: (1) technical considerations and sources of error in measurement of peak velocity, mean aortic valve gradient and aortic valve area by continuity equation...
March 23, 2018: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/29566813/low-flow-low-gradient-aortic-stenosis-tavr-in-dobutamine-stress-echocardiography-out
#6
EDITORIAL
Philippe Généreux
No abstract text is available yet for this article.
March 27, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29566812/transcatheter-aortic-valve-replacement-in-patients-with-low-flow-low-gradient-aortic-stenosis-the-topas-tavi-registry
#7
Henrique Barbosa Ribeiro, Stamatios Lerakis, Martine Gilard, João L Cavalcante, Raj Makkar, Howard C Herrmann, Stephan Windecker, Maurice Enriquez-Sarano, Asim N Cheema, Luis Nombela-Franco, Ignacio Amat-Santos, Antonio J Muñoz-García, Bruno Garcia Del Blanco, Alan Zajarias, John C Lisko, Salim Hayek, Vasilis Babaliaros, Florent Le Ven, Thomas G Gleason, Tarun Chakravarty, Wilson Y Szeto, Marie-Annick Clavel, Alberto de Agustin, Vicenç Serra, John T Schindler, Abdellaziz Dahou, Rishi Puri, Emilie Pelletier-Beaumont, Melanie Côté, Philippe Pibarot, Josep Rodés-Cabau
BACKGROUND: Few data exist on patients with low-flow, low-gradient aortic stenosis (LFLG-AS) undergoing transcatheter aortic valve replacement (TAVR). Also, very scarce data exist on the usefulness of dobutamine stress echocardiography (DSE) before TAVR in these patients. OBJECTIVES: The authors sought to evaluate clinical outcomes and changes in left ventricular ejection fraction (LVEF) following TAVR in patients with classical LFLG-AS. METHODS: This multicenter registry included 287 patients with LFLG-AS undergoing TAVR...
March 27, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29561991/an-alternative-method-to-calculate-simplified-projected-aortic-valve-area-at-normal-flow-rate
#8
Joana Sofia Silva Moura Ferreira, Nádia Moreira, Rita Ferreira, Sofia Mendes, Rui Martins, Maria João Ferreira, Mariano Pego
BACKGROUND: Simplified projected aortic valve area (EOAproj) is a valuable echocardiographic parameter in the evaluation of low flow low gradient aortic stenosis (LFLG AS). Its widespread use in clinical practice is hampered by the laborious process of flow rate (Q) calculation. OBJETIVE: This study proposes a less burdensome, alternative method of Q calculation to be incorporated in the original formula of EOAproj and measures the agreement between the new proposed method of EOAproj calculation and the original one...
February 2018: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/29561987/low-flow-low-gradient-and-low-ejection-fraction-aortic-stenosis-and-projected-aortic-valve-area-calculation-so-important-but-so-complicated-let-us-just-keep-it-simple
#9
EDITORIAL
Wilson Mathias Junior
No abstract text is available yet for this article.
February 2018: Arquivos Brasileiros de Cardiologia
https://www.readbyqxmd.com/read/29558902/emergency-transcatheter-aortic-valve-replacement-for-a-patient-with-decompensated-severe-aortic-stenosis-accompanied-by-cardiorenal-syndrome-a-case-report
#10
Hongju Kim, Jung-Hee Lee
BACKGROUND: Severe aortic stenosis (AS) may lead to acute decompensated heart failure resistant to medical treatment. Here, we report a successful emergent transcatheter aortic valve replacement (TAVR) in a patient presenting with decompensated severe AS accompanied by cardiorenal syndrome. CASE PRESENTATION: A 82-year-old man presented at our emergency department with aggravated dyspnea. His chest X-ray showed bilateral pulmonary edema, and laboratory examination revealed acute kidney injury...
March 20, 2018: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/29550325/transaortic-flow-rate-versus-stroke-volume-index-in-low-gradient-aortic-stenosis
#11
EDITORIAL
Crochan J O'Sullivan, Ernest Spitzer
No abstract text is available yet for this article.
March 9, 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29550315/low-transvalvular-flow-rate-predicts-mortality-in-patients-with-low-gradient-aortic-stenosis-following-aortic-valve-intervention
#12
Anastasia Vamvakidou, Wenying Jin, Oleksandr Danylenko, Navtej Chahal, Rajdeep Khattar, Roxy Senior
OBJECTIVES: This study aimed to assess the value of low transvalvular flow rate (FR) for the prediction of mortality compared with low stroke volume index (SVi) in patients with low-gradient (mean gradient: <40 mm Hg), low aortic valve area (<1 cm2 ) aortic stenosis (AS) following aortic valve intervention. BACKGROUND: Transaortic FR defined as stroke volume/left ventricular ejection time is also a marker of flow; however, no data exist comparing the relative prognostic value of these 2 transvalvular flow markers in patients with low-gradient AS who had undergone valve intervention...
March 9, 2018: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/29547988/impact-of-low-stroke-volume-on-mortality-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction
#13
Dan Rusinaru, Yohann Bohbot, Anne Ringle, Sylvestre Maréchaux, Momar Diouf, Christophe Tribouilloy
Aims: In patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), low flow (LF) is currently defined using Doppler-echocardiography by a stroke volume index (SVi)<35 mL/m2. However, the relationship between LF and outcome remains unclear as data on normal reference values defining LF are scarce, and previous studies did not explore the risk associated with other SVi cut-points. We analysed the relationship between LF and mortality in severe AS to establish prognostic LF values associated with mortality risk...
March 13, 2018: European Heart Journal
https://www.readbyqxmd.com/read/29522643/anatomic-estimation-of-aortic-stenosis-severity-vs-fusion-of-data-from-computed-tomography-and-doppler-echocardiography
#14
Nikolaus Jander, Susanne Wienecke, Stephan Dorfs, Philipp Ruile, Franz-Josef Neumann, Gregor Pache, Jan Minners
AIM: Two-dimensional, transthoracic echocardiography does not account for the noncircular anatomy of the left ventricular outflow tract (LVOT) and may therefore underestimate LVOT area. Fusion of computed tomography (CT)-derived LVOT area and Doppler-derived flow data has been proposed to improve assessment of aortic valve area (AVA) and classification of aortic stenosis severity. For hemodynamic reasons, effective AVA has to be smaller than anatomic AVA. The aim of the study was to test the "fusion approach" by comparing effective CT-derived AVA with anatomic AVA from CT planimetry...
March 9, 2018: Echocardiography
https://www.readbyqxmd.com/read/29455849/relationship-between-proximal-aorta-morphology-and-progression-rate-of-aortic-stenosis
#15
Romain Capoulade, Jonathan G Teoh, Philipp E Bartko, Eliza Teo, Jan-Erik Scholtz, Lionel Tastet, Mylene Shen, Christos G Mihos, Yong H Park, Julio Garcia, Eric Larose, Eric M Isselbacher, Thoralf M Sundt, Thomas E MacGillivray, Serguei Melnitchouk, Brian B Ghoshhajra, Philippe Pibarot, Judy Hung
BACKGROUND: The aim of this study was to examine the association between abnormal morphology of the proximal aorta and aortic stenosis (AS) progression rate. The main hypothesis was that morphologic changes of the proximal aorta, such as effacement of the sinotubular junction (STJ), result in increased biomechanical stresses and contribute to calcification and progression of AS. METHODS: Between 2010 and 2012, 426 patients with mild to moderate AS were included in this study...
May 2018: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/29439881/prospective-assessment-of-the-frequency-of-low-gradient-severe-aortic-stenosis-with-preserved-left-ventricular-ejection-fraction-critical-impact-of-aortic-flow-misalignment-and-pressure-recovery-phenomenon
#16
Anne Ringle, Anne-Laure Castel, Caroline Le Goffic, François Delelis, Camille Binda, Yohan Bohbot, Pierre Vladimir Ennezat, Raphaëlle A Guerbaai, Franck Levy, André Vincentelli, Pierre Graux, Christophe Tribouilloy, Sylvestre Maréchaux
BACKGROUND: The frequency of paradoxical low-gradient severe aortic stenosis (AS) varies widely across studies. The impact of misalignment of aortic flow and pressure recovery phenomenon on the frequency of low-gradient severe AS with preserved left ventricular ejection fraction (LVEF) has not been evaluated in prospective studies. AIMS: To investigate prospectively the impact of aortic flow misalignment by Doppler and lack of pressure recovery phenomenon correction on the frequency of low-gradient (LG) severe aortic stenosis (AS) with preserved LVEF...
February 10, 2018: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/29406852/evaluating-patients-with-low-flow-low-gradient-aortic-stenosis-by-dobutamine-echocardiography-it-s-complicated
#17
EDITORIAL
Paul A Grayburn
No abstract text is available yet for this article.
February 6, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29406851/dobutamine-stress-echocardiography-for-management-of-low-flow-low-gradient-aortic-stenosis
#18
Mohamed-Salah Annabi, Eden Touboul, Abdellaziz Dahou, Ian G Burwash, Jutta Bergler-Klein, Maurice Enriquez-Sarano, Stefan Orwat, Helmut Baumgartner, Julia Mascherbauer, Gerald Mundigler, João L Cavalcante, Éric Larose, Philippe Pibarot, Marie-Annick Clavel
BACKGROUND: In the American College of Cardiology/American Heart Association guidelines, patients are considered to have true-severe stenosis when the mean gradient (MG) is ≥40 mm Hg with an aortic valve area (AVA) ≤1 cm2 during dobutamine stress echocardiography (DSE). However, these criteria have not been previously validated. OBJECTIVES: The aim of this study was to assess the value of these criteria to predict the presence of true-severe AS and the occurrence of death in patients with low-flow, low-gradient aortic stenosis (LF-LG AS)...
February 6, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29402710/safety-and-utility-of-dobutamine-and-pressure-wire-use-in-the-hemodynamic-assessment-of-low-flow-low-gradient-aortic-stenosis-with-reduced-left-ventricular-ejection-fraction
#19
Zaher Fanari, Prasad C Gunasekaran, Arslan Shaukat, Sumaya Hammami, Buddhadeb Dawn, Mark Wiley, Peter Tadros
BACKGROUND: The ACC/AHA guidelines recommend low-dose dobutamine challenge for hemodynamic assessment of the severity of AS in patients with low flow, low gradient aortic stenosis with reduced ejection fraction (EF) (LFLG-AS; stage D2). Inherent pitfalls of echocardiography could result in inaccurate aortic valve areas (AVA), which have downstream prognostic implications. Data on the safety and efficacy of coronary pressure wire and fluid-filled catheter use for low dose dobutamine infusion is sparse...
October 5, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/29395002/resolving-apparent-inconsistencies-between-area-flow-and-gradient-measurements-in-patients-with-aortic-valve-stenosis-and-preserved-left-ventricular-ejection-fraction
#20
Yujing Mo, Martin Penicka, Giuseppe Di Gioia, Emanuele Barbato, Tomas Ondrus, Marc Vanderheyden, Bernard De Bruyne, Jozef Bartunek, Guy Van Camp
Inconsistencies between area (aortic valve area [AVA])-flow-gradient are common during the echocardiographic assessment of aortic stenosis (AS). This study was conducted to investigate the importance of these inconsistencies and the impact of 3 methods to resolve these inconsistencies. The study population consisted of 327 patients (age: 76.3 ± 8.6 years, 49.5% males) with severe AS (SAS) (AVA ≤ 1 cm2 ) and preserved left ventricular ejection fraction (≥50%). Inconsistent findings between AVA, flow, and mean gradient (MG) were observed in 78 (23...
March 15, 2018: American Journal of Cardiology
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