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low flow low gradient aortic stenosis

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https://www.readbyqxmd.com/read/28917673/b-type-natriuretic-peptide-and-high-sensitivity-cardiac-troponin-for-risk-stratification-in-low-flow-low-gradient-aortic-stenosis-a-substudy-of-the-topas-study
#1
Abdellaziz Dahou, Marie-Annick Clavel, Romain Capoulade, Kim O'Connor, Henrique B Ribeiro, Nancy Côté, Florent Le Ven, Josep Rodés-Cabau, Jean G Dumesnil, Patrick Mathieu, Philippe Pibarot
OBJECTIVES: The objective of this study was to determine the prognostic value of combined measures of B-type natriuretic peptide (BNP) and high-sensitivity cardiac troponin T (hsTnT) in patients with low-flow, low-gradient aortic stenosis (LF-LG AS) who had either a preserved or reduced left ventricular ejection fraction (LVEF). BACKGROUND: An elevated BNP level is associated with increased risk of mortality in patients with LF-LG AS. The incremental prognostic value of hsTnT in these patients is unknown...
September 9, 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28901639/predicting-changes-in-flow-category-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction-on-medical-therapy
#2
Jinghao Nicholas Ngiam, Ivandito Kuntjoro, Benjamin Y Q Tan, Hui-Wen Sim, William K F Kong, Tiong-Cheng Yeo, Kian-Keong Poh
BACKGROUND/OBJECTIVES: Controversy surrounds the prognosis and management of patients with paradoxical low-flow severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF). It was not certain if patients in a particular flow category remained in the same category as disease progressed. We investigated whether there were switches in categories and if so, their predictors. METHODS: Consecutive subjects (n = 203) with isolated severe AS and paired echocardiography (>180 days apart) were studied...
September 13, 2017: Echocardiography
https://www.readbyqxmd.com/read/28882231/hemodynamic-response-to-nitroprusside-in-patients-with-low-gradient-severe-aortic-stenosis-and-preserved-ejection-fraction
#3
COMPARATIVE STUDY
James W Lloyd, Rick A Nishimura, Barry A Borlaug, Mackram F Eleid
BACKGROUND: Low-gradient severe aortic stenosis (LGSAS) with preserved ejection fraction (EF) is incompletely understood. The influence of arterial afterload and diastolic dysfunction on the hemodynamic presentation of LGSAS remains unknown. OBJECTIVES: The authors sought to determine the acute hemodynamic response to sodium nitroprusside in LGSAS with preserved EF. METHODS: Symptomatic patients with LGSAS and preserved EF underwent cardiac catheterization with comparison of hemodynamic measurements before and after nitroprusside...
September 12, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28870874/characteristics-and-outcome-following-transcatheter-aortic-valve-replacement-of-patients-with-severe-aortic-stenosis-with-low-flow
#4
Yigal Abramowitz, Tarun Chakravarty, Philippe Pibarot, Yoshio Maeno, Hiroyuki Kawamori, David Anderson, Geeteshwar Mangat, Mamoo Nakamura, Wen Cheng, Raj R Makkar
AIMS: Only few studies examined the respective impact of low flow (LF), low gradient (LG) and low ejection fraction (LEF) on outcomes following transcatheter aortic valve replacement (TAVR). The purpose of this study was to assess the impact of pre-procedural stroke volume index, aortic valve gradient, left ventricular ejection fraction (LVEF) and different flow/gradient/LVEF patterns on the clinical outcomes of patients with severe aortic stenosis (AS) that undergo TAVR. METHODS AND RESULTS: We analyzed the clinical, echocardiographic, and outcome data collected in 770 patients with AS that underwent TAVR...
September 5, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28867024/impact-of-stroke-volume-assessment-by-integrating-multi-detector-computed-tomography-and-doppler-data-on-the-classification-of-aortic-stenosis
#5
Barbara E Stähli, Thomas Stadler, Erik W Holy, Thi Dan Linh Nguyen-Kim, Lisa Hoffelner, Ladina Erhart, Slayman Obeid, Markus Niemann, Rolf Jenni, Sandra Hamada, Robert Manka, Thomas F Lüscher, Francesco Maisano, Fabian Nietlispach, Thomas Frauenfelder, Felix C Tanner
BACKGROUND: The prevalence of low flow low gradient (LFLG) severe aortic stenosis (AS) may be overrated due to underestimation of stroke volume in two-dimensional (2D) echocardiography. The implications of 3D imaging on stroke volume calculation for AS classification have not been elucidated. Integrating multi-detector computed tomography (MDCT) and Doppler data may improve diagnostic accuracy in patients with LFLG AS. METHODS: A total of 186 patients with severe AS evaluated for transcatheter aortic valve replacement were classified according to indexed stroke volume (SVI, cut-off 35mL/m(2)) and mean transaortic pressure gradient (cut-off 40mmHg)...
November 1, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28864136/severe-aortic-stenosis-patients-with-preserved-ejection-fraction-according-to-flow-and-gradient-classification-prevalence-and-outcomes
#6
Ariana González Gómez, Covadonga Fernández-Golfín, Juan Manuel Monteagudo, Carlos Izurieta, Rocío Hinojar, Ana García, Eduardo Casas, José Julio Jiménez-Nacher, José Luis Moya, Soledad Ruiz, José Luis Zamorano
BACKGROUND: Clinicians often encounter patients with apparently discordant echocardiographic findings, severe aortic stenosis (SAS) defined by aortic valve area (AVA) despite a low mean gradient. A new classification according to flow state and pressure gradient has been proposed. We sought to assess the prevalence, characteristics and outcomes of patients with asymptomatic SAS with preserved left-ventricular ejection fraction (LVEF) according to flow and gradient. METHODS AND RESULTS: In total 442 patients with SAS (AVAi<0...
August 29, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28846524/outcome-of-patients-with-low-flow-low-gradient-severe-aortic-stenosis-who-underwent-aortic-valve-replacement
#7
Xing Li Fan, Jiajun Zhang, Chong Wang, Hongmei Chong, Guanxin Zhang, Qing Xue, Yangfeng Tang, Lin Han
It is well-documented that stroke volume and gradient are indexed to classify patients with aortic stenosis into several phenotypes. The purpose of the present study was to estimate the impact of stroke volume and gradient on the clinical outcome of patients with AS who have undergone aortic valve replacement. Methods: A total of 154 consecutive patients were studied. They all had severe aortic stenosis (aortic valve area [AVA] ≤ 1 cm², left ventricular ejection fraction [LVEF] ≥ 50%) and underwent aortic valve replacement (AVR) from January 1, 2004 to December 31, 2010...
July 20, 2017: Heart Surgery Forum
https://www.readbyqxmd.com/read/28828046/modern-use-of-echocardiography-in-transcatheter-aortic-valve-replacement-an-up-date
#8
Cristina Caldararu, Serban Balanescu
Echocardiography is the cornerstone in the diagnosis of any valvular heart disease. The accurate diagnosis of aortic stenosis, the left ventricle function and the other heart valves evaluation are currently done by ultrasound alone. Prosthetic valve choice and dimensions prior to implantation can be done solely by proper use of echocardiography. The emergence of new methods to cure aortic stenosis such as trans-catheter aortic valve replacement (TAVR) emphasized the diagnostic value of cardiac ultrasound. The usefulness of echocardiography in TAVR can be divided in the baseline assessment (common to patients treated by conventional surgery), intra-procedural guidance of valve deployment and post-procedural follow-up...
December 2016: Mædica
https://www.readbyqxmd.com/read/28814490/clinical-features-and-prognosis-of-patients-with-isolated-severe-aortic-stenosis-and-valve-area-less-than-1-0-cm-2
#9
Praveen Mehrotra, Katrijn Jansen, Timothy C Tan, Aidan Flynn, Judy W Hung
OBJECTIVE: Current guidelines define severe aortic stenosis (AS) as an aortic valve area (AVA)≤1.0 cm(2), but some authors have suggested that the AVA cut-off be decreased to 0.8 cm(2). The aim of this study was, therefore, to better describe the clinical features and prognosis of patients with an AVA of 0.8-0.99 cm(2). METHODS: Patients with isolated, severe AS and ejection fraction ≥55% with an AVA of 0.8-0.99 cm(2) (n=105) were compared with those with an AVA<0...
August 16, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28808772/longitudinal-strain-assessed-by-cardiac-magnetic-resonance-correlates-to-hemodynamic-findings-in-patients-with-severe-aortic-stenosis-and-predicts-positive-remodeling-after-transcatheter-aortic-valve-replacement
#10
Dominik Buckert, Maciej Cieslik, Raid Tibi, Michael Radermacher, Volker Rasche, Peter Bernhardt, Vinzenz Hombach, Wolfgang Rottbauer, Jochen Wöhrle
AIMS: To assess left-ventricular strain parameters before and after transcatheter aortic valve replacement (TAVR) by feature tracking cardiac magnetic resonance imaging (FT CMR) and to correlate the findings to hemodynamic state and left-ventricular remodeling. METHODS AND RESULTS: Patients with symptomatic AS underwent FT CMR before and after TAVR. Patients were carefully evaluated by a comprehensive work-up including CMR, echocardiography and left and right heart catheterization...
August 14, 2017: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
https://www.readbyqxmd.com/read/28797414/lower-transaortic-flow-rate-is-associated-with-increased-mortality-in-aortic-valve%C3%A2-stenosis
#11
Sahrai Saeed, Roxy Senior, Navtej S Chahal, Mai Tone Lønnebakken, John B Chambers, Edda Bahlmann, Eva Gerdts
OBJECTIVES: The association of transaortic flow rate (FR) with outcomes was tested in 1,661 patients with aortic valve stenosis (AS) in the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study. BACKGROUND: Low transaortic flow may complicate grading of AS. However, the association of lower transaortic FR with adverse outcomes has not been reported. METHODS: Transaortic FR was calculated from Doppler-derived stroke volume in milliliters divided by systolic ejection time in seconds and considered low if <200 ml/s...
August 2017: JACC. Cardiovascular Imaging
https://www.readbyqxmd.com/read/28794053/low-flow-severe-aortic-stenosis-evolving-role-of-transcatheter-aortic-valve-replacement
#12
REVIEW
Matthew D Saybolt, Paul N Fiorilli, Zachary M Gertz, Howard C Herrmann
The definition of severe aortic stenosis has classically and retrospectively been based on the natural history of patients with medically managed aortic stenosis and preserved left ventricular function in an era where surgical aortic valve replacement was the sole therapy. We now recognize that this disease is more heterogeneous and includes important subsets of patients with low stroke volume index (low flow) and low-gradient with reduced (classical) or preserved (paradoxical) ejection fraction. These patients pose diagnostic and treatment dilemmas, requiring a comprehensive assessment with integration of multimodality imaging, testing, and clinical assessment...
August 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28781116/acceleration-time-and-ratio-of-acceleration-time%C3%A2-to-ejection-time-in-aortic-stenosis-new%C3%A2-echocardiographic-diagnostic-parameters
#13
Sergio Gamaza-Chulián, Enrique Díaz-Retamino, Santiago Camacho-Freire, Dolores Ruiz-Fernández, Alejandro Gutiérrez-Barrios, Jesús Oneto-Otero
BACKGROUND: Inconsistencies between gradients and aortic valve area are frequent in the echocardiographic evaluation of aortic stenosis (AS). Assessing AS severity is essential for the correct management of the disease. The aim of this study was to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), could be diagnostic parameters in patients with AS. METHODS: Patients with AS (aortic peak velocity > 2 m/sec) were prospectively enrolled...
August 3, 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28735253/how-should-i-treat-a-patient-with-a-symptomatic-and-severe-low-flow-low-gradient-aortic-stenosis-and-an-incidental-abdominal-aortic-aneurysm
#14
Zouhair Rahhab, Sander Ten Raa, Nathalie van der Ploeg, Nicolas M Van Mieghem, Hence Verhagen, Peter P T de Jaegere, Mani Arsalan, Won Kim, Thomas Walther, Didier Tchétché
No abstract text is available yet for this article.
July 20, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28715078/polish-stress-echocardiography-registry-pol-stress-registry-a-multicenter-study-stress-echo-in-poland-numbers-settings-results-and-complications
#15
Edyta Płońska-Gościniak, Jarosław D Kasprzak, Szymon Olędzki, Jolanta Rzucidło-Resil, Piotr Gościniak, Tomasz Kukulski, Katarzyna Mizia-Stec, Wojciech Kosmala, Dariusz Kosior, Marta Marcinkiewicz-Siemion, Barbara Brzezińska, Beata Zaborska, Marcin Fijałkowski, Iwona Świątkiewicz, Andrzej Szyszka, Jan Błażejewski, Wojciech Witkiewicz, Zbigniew Gąsior, Danuta Sorysz, Agnieszka Olszanecka
BACKGROUND: Stress echocardiography (SE) is widely used in Europe. No collective data have been available on the use of SE in Poland until now. AIM: To evaluate the number of SE investigations performed in Poland, their settings, complications and results. METHODS: In this retrospective survey, referral cardiology centers in Poland were asked to fill in a questionnaire regarding SE examinations performed from May 01, 2014 to May 01, 2015. RESULTS: The study included data from 17 university hospitals and large community hospitals which performed 4611 SE examinations, including 4408 tests in patients investigated for coronary artery disease (CAD) and 203 tests to evaluate valvular heart disease (VHD)...
July 17, 2017: Kardiologia Polska
https://www.readbyqxmd.com/read/28698585/effects-of-aortic-valve-replacement-on-severe-aortic-stenosis-and-preserved-systolic-function-systematic-review-and-network-meta-analysis
#16
Qishi Zheng, Andie H Djohan, Enghow Lim, Zee Pin Ding, Lieng H Ling, Luming Shi, Edwin Shih-Yen Chan, Calvin Woon Loong Chin
The survival benefits of aortic valve replacement (AVR) in the different flow-gradient states of severe aortic stenosis (AS) is not known. A comprehensive search in PubMed/MEDLINE, Embase, Cochrane Library, CNKI and OpenGrey were conducted to identify studies that investigated the prognosis of severe AS (effective orifice area ≤1.0 cm(2)) and left ventricular ejection fraction ≥50%. Severe AS was stratified by mean pressure gradient [threshold of 40 mmHg; high-gradient (HG) and low-gradient (LG)] and stroke volume index [threshold of 35 ml/m(2); normal-flow (NL) and low-flow (LF)]...
July 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28687561/impact-of-vascular-hemodynamics-on-aortic-stenosis-evaluation-new-insights-into-the-pathophysiology-of-normal-flow-small-aortic-valve-area-low-gradient-pattern
#17
Nancy Côté, Louis Simard, Anne-Sophie Zenses, Lionel Tastet, Mylène Shen, Marine Clisson, Marie-Annick Clavel
BACKGROUND: About 50% of normal-flow/low-gradient patients (ie, low mean gradient [MG] or peak aortic jet velocity and small aortic valve area) have severe aortic valve calcification as measured by computed tomography. However, they are considered to have moderate aortic stenosis (AS) in current American College of Cardiology/American Heart Association guidelines. The objective was thus to evaluate the effect of hypertension and reduced arterial compliance (rAC) on MG and Vpeak measurements...
July 7, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28684437/the-role-and-clinical-implications-of-diastolic-dysfunction-in-aortic-stenosis
#18
REVIEW
Polydoros N Kampaktsis, Damianos G Kokkinidis, Shing-Chiu Wong, Manolis Vavuranakis, Nikolaos J Skubas, Richard B Devereux
Diastolic dysfunction in aortic stenosis results primarily from left ventricular hypertrophy and myocardial fibrosis due to chronically elevated left ventricular systolic pressure. Currently, diastolic dysfunction does not have an explicit clinical role in management of patients with aortic stenosis. Studies have shown that improvement in diastolic dysfunction follows left ventricular remodelling after aortic valve replacement and that it occurs gradually or incompletely. Retrospective studies suggest that advanced grades of diastolic dysfunction at baseline are associated with increased mortality and adverse events even after aortic valve replacement...
October 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28599829/noninvasive-coronary-flow-reserve-predicts-response-to-exercise-in-asymptomatic-severe-aortic-stenosis
#19
Patrick Meimoun, Daniel Czitrom, Jérome Clerc, Jean Christophe Seghezzi, Sonia Martis, Alain Berrebi, Frederic Elmkies
BACKGROUND: In patients with asymptomatic aortic stenosis (AS), exercise stress echocardiography (ESE) provides additional prognostic information beyond baseline. The coronary flow velocity reserve (CFVR) is impaired in AS, but its link with exertion is unknown in this setting. The aim of this study was to test the hypothesis that CFVR could predict exercise capacity and abnormal exercise test results in AS. METHODS: Noninvasive CFVR and symptom-limited semisupine ESE were prospectively performed the same day in 43 patients with asymptomatic isolated severe AS (mean age, 68...
August 2017: Journal of the American Society of Echocardiography
https://www.readbyqxmd.com/read/28597027/-low-flow-low-gradient-aortic-valve-stenosis-current-evidence
#20
F Tillwich, M A Sherif, S Yücel, A Öner, H Ince
Many patients with severe aortic stenosis have a "low-flow, low-gradient" aortic stenosis. The management of these patients can be quite difficult, as these patients often show impairment of the left ventricle, which can lead to false measurements of the severity of stenosis and also leads to a higher risk during aortic valve replacement. More diagnostic tools than only standard echocardiography are needed to correctly differentiate true severe aortic stenosis from pseudo severe aortic stenosis.
June 9, 2017: Herz
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