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102
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Hagendorff A, Knebel F, Helfen A, Knierim J, Sinning C, Stöbe S, Fehske W, Ewen S. Expert consensus document on the assessment of the severity of aortic valve stenosis by echocardiography to provide diagnostic conclusiveness by standardized verifiable documentation. Clin Res Cardiol 2019; 109:271-288. [PMID: 31482241 DOI: 10.1007/s00392-019-01539-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
According to recent recommendations on echocardiographic assessment of aortic valve stenosis direct measurement of transvalvular peak jet velocity, calculation of transvalvular mean gradient from the velocities using the Bernoulli equation and calculation of the effective aortic valve area by continuity equation are the appropriate primary key instruments for grading severity of aortic valve stenosis. It is obvious that no gold standard can be declared for grading the severity of aortic stenosis. Thus, conclusions of the exclusive evaluation of aortic stenosis by Doppler echocardiography seem to be questionable due to the susceptibility to errors caused by methodological limitations, mathematical simplifications and inappropriate documentation. The present paper will address practical issues of echocardiographic documentation to satisfy the needs to analyze different scenarios of aortic stenosis due to various flow conditions and pressure gradients. Transesophageal and multidimensional echocardiography should be implemented for reliable measurement of geometric aortic valve area and of cardiac dimensions at an early stage of the diagnostic procedure to avoid misinterpretation due to inconsistent results.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University of Leipzig, Klinik und Poliklinik für Kardiologie, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology and Angiology, Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Helfen
- Department of Cardiology, St. Marien Hospital Lünen, Altstadtstraße 23, 44534, Lünen, Germany
| | - Jan Knierim
- Department of Cardiovascular Surgery, University of Berlin, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Sinning
- Department of Cardiology, University of Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
| | - Stephan Stöbe
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Wolfgang Fehske
- Department of Cardiology St, Vinzenz-Hospital Köln, Merheimer Straße 221, 50733, Köln, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Str., 66421, Homburg, Germany
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103
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Guzzetti E, Pibarot P, Clavel MA. Normal-flow low-gradient severe aortic stenosis is a frequent and real entity. Eur Heart J Cardiovasc Imaging 2019; 20:1102-1104. [DOI: 10.1093/ehjci/jez211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec Heart and Lung Institute, 2725 Chemin Sainte-Foy, Québec city, Quebec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec Heart and Lung Institute, 2725 Chemin Sainte-Foy, Québec city, Quebec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec Heart and Lung Institute, 2725 Chemin Sainte-Foy, Québec city, Quebec, Canada
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104
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Barberato SH, Romano MMD, Beck ALDS, Rodrigues ACT, Almeida ALCD, Assunção BMBL, Gripp EDA, Guimarães Filho FV, Abensur H, Castillo JMD, Miglioranza MH, Vieira MLC, Barros MVLD, Nunes MDCP, Otto MEB, Hortegal RDA, Barretto RBDM, Campos TH, Siqueira VND, Morhy SS. Position Statement on Indications of Echocardiography in Adults - 2019. Arq Bras Cardiol 2019; 113:135-181. [PMID: 31411301 PMCID: PMC6684182 DOI: 10.5935/abc.20190129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
| | - Minna Moreira Dias Romano
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP - Brazil
| | - Adenalva Lima de Souza Beck
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brazil.,Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil
| | - Ana Clara Tude Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil.,DASA, São Paulo, SP - Brazil
| | | | - Henry Abensur
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brazil
| | | | - Marcelo Haertel Miglioranza
- Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil.,Instituto de Cardiologia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Márcio Vinicius Lins de Barros
- Faculdade de Saúde e Ecologia Humana (FASEH), Vespasiano, MG - Brazil.,Rede Materdei de Saúde, Belo Horizonte, MG - Brazil.,Hospital Vera Cruz, Belo Horizonte, MG - Brazil
| | | | | | | | | | - Thais Harada Campos
- Diagnoson-Fleury, Salvador, BA - Brazil.,Hospital Ana Nery, Salvador, BA - Brazil
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105
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Adda J, Stanova V, Zenses AS, Clavel MA, Barragan P, Penaranda G, Habib G, Pibarot P, Rieu R. Discordant Grading of Aortic Stenosis Severity: New Insights from an In Vitro Study. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1632507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Jérôme Adda
- Department of Cardiology, University Hospital Arnaud de Villeneuve, Montpellier, France
| | | | - Anne-Sophie Zenses
- Aix-Marseille University, LBA-UMRT24 IFSTTAR, Marseille, France
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | | | - Paul Barragan
- Department of Cardiology, Polyclinique les Fleurs, Ollioules, France
| | | | - Gilbert Habib
- Department of Cardiology, Hospital La Timone, Insuffisance Cardiaque et Valvulopathie, Marseille, France
| | - Philippe Pibarot
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec, Canada
| | - Régis Rieu
- Aix-Marseille University, LBA-UMRT24 IFSTTAR, Marseille, France
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106
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Contemporary Imaging of Aortic Stenosis. Heart Lung Circ 2019; 28:1310-1319. [PMID: 31266725 DOI: 10.1016/j.hlc.2019.05.177] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/29/2019] [Accepted: 05/17/2019] [Indexed: 12/26/2022]
Abstract
Degenerative or fibrocalcific aortic stenosis (AS) is now the most common native valvular heart disease assessed and managed by cardiologists in developed countries. Transthoracic echocardiography remains the quintessential imaging modality for the non-invasive characterisation of AS due to its widespread availability, superior assessment of flow haemodynamics, and a wealth of prognostic data accumulated over decades of clinical utility and research applications. With expanding technologies and increasing availability of treatment options such as transcatheter aortic valve replacements, in addition to conventional surgical approaches, accurate and precise assessment of AS severity is critical to guide decisions for and timing of interventions. Despite clear guideline echocardiographic parameters demarcating severe AS, discrepancies between transvalvular velocities, gradients, and calculated valve areas are commonly encountered in clinical practice. This often results in diagnostically challenging cases with significant implications. Greater emphasis must be placed on the quality of performance of basic two dimensional (2D) and Doppler measurements (attention to detail ensuring accuracy and precision), incorporating ancillary haemodynamic surrogates, understanding study- or patient-specific confounders, and recognising the role and limitations of stress echocardiography in the subgroups of low-flow low-gradient AS. A multiparametric approach, along with the incorporation of multimodality imaging (cardiac computed tomography or magnetic resonance imaging) in certain scenarios, is now mandatory to avoid incorrect misclassification of severe AS. This is essential to ensure appropriate selection of patients who would most benefit from interventions on the aortic valve to relieve the afterload mismatch resulting from truly severe valvular stenosis.
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107
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Zamorano JL, Rodríguez P. JA, Venegas M. M. Estenosis aórtica de bajo flujo y bajo gradiente. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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108
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Rosa VE, Ribeiro HB, Sampaio RO, Morais TC, Rosa ME, Pires LJ, Vieira ML, Mathias W, Rochitte CE, de Santis AS, Fernandes JRC, Accorsi TA, Pomerantzeff PM, Rodés-Cabau J, Pibarot P, Tarasoutchi F. Myocardial Fibrosis in Classical Low-Flow, Low-Gradient Aortic Stenosis. Circ Cardiovasc Imaging 2019; 12:e008353. [DOI: 10.1161/circimaging.118.008353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Vitor E.E. Rosa
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Henrique B. Ribeiro
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Roney O. Sampaio
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Thamara C. Morais
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Marcela E.E. Rosa
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Lucas J.T. Pires
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Marcelo L.C. Vieira
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Wilson Mathias
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Carlos E. Rochitte
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Antonio S.A.L. de Santis
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Joao Ricardo C. Fernandes
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Tarso A.D. Accorsi
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Pablo M.A. Pomerantzeff
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., P.P.)
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada (J.R.-C., P.P.)
| | - Flavio Tarasoutchi
- Heart Institute (InCor) Clinical Hospital, University of Sao Paulo, Brazil (V.E.E.R., H.B.R., R.O.S., T.C.M., M.E.E.R., L.J.T.P., M.L.C.V., W.M., C.E.R., A.S.A.L.d.S., J.R.C.F., T.A.D.A., P.M.A.P., F.T.)
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109
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The new place of imaging in cardiology, from diagnosis to treatment. Arch Cardiovasc Dis 2019; 112:543-545. [PMID: 31027901 DOI: 10.1016/j.acvd.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 03/18/2019] [Indexed: 11/21/2022]
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110
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How Do We Reconcile Echocardiography, Computed Tomography, and Hybrid Imaging in Assessing Discordant Grading of Aortic Stenosis Severity? JACC Cardiovasc Imaging 2019; 12:267-282. [DOI: 10.1016/j.jcmg.2018.11.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/12/2018] [Accepted: 11/14/2018] [Indexed: 12/18/2022]
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111
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Malkowski MJ. Comprehensive Assessment of Aortic Stenosis in the TAVR Era. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9469-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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112
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D'Souza GA, Banerjee RK, Taylor MD. Evaluation of pulmonary artery stenosis in congenital heart disease patients using functional diagnostic parameters: An in vitro study. J Biomech 2018; 81:58-67. [PMID: 30293825 DOI: 10.1016/j.jbiomech.2018.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/23/2018] [Accepted: 09/13/2018] [Indexed: 02/03/2023]
Abstract
Congenital pulmonary artery (PA) stenosis is often associated with abnormal PA hemodynamics including increased pressure drop (Δp) and reduced asymmetric flow (Q), which may result in right ventricular dysfunction. We propose functional diagnostic parameters, pressure drop coefficient (CDP), energy loss (Eloss), and normalized energy loss (E¯loss) to characterize pulmonary hemodynamics, and evaluate their efficacy in delineating stenosis severity using in vitro experiments. Subject-specific test sections including the main PA (MPA) bifurcating into left and right PAs (LPA, RPA) with a discrete LPA stenosis were manufactured from cross-sectional imaging and 3D printing. Three clinically-relevant stenosis severities, 90% area stenosis (AS), 80% AS, and 70% AS, were evaluated at different cardiac outputs (COs). A benchtop flow loop simulating pulmonary hemodynamics was used to measure Q and Δp within the test sections. The experimental Δp-Q characteristics along with clinical data were used to obtain pathophysiologic conditions and compute the diagnostic parameters. The pathophysiologic QLPA decreased as the stenosis severity increased at a fixed CO. CDPLPA, Eloss,LPA (absolute), and E¯loss,LPA (absolute) increased with an increase in LPA stenosis severity at a fixed CO. Importantly, CDPLPA and E¯loss,LPA had reduced variability with CO, and distinct values for each LPA stenosis severity. Under variable CO, a) CDPLPA values were 14.5-21.0 (70% AS), 60.7- 2.2 (80% AS), ≥ 261.6 (90% AS), and b) E¯loss,LPA values (in mJ per QLPA) were -501.9 to -1023.8 (70% AS), -1247.6 to -1773.0 (80% AS), -1934.5 (90% AS). Hence, CDPLPA and E¯loss,LPA are expected to assess the true functional severity of PA stenosis.
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Affiliation(s)
- Gavin A D'Souza
- Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Rupak K Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH, USA.
| | - Michael D Taylor
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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113
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Shah B, McDonald D, Paone D, Redel-Traub G, Jangda U, Guo Y, Saric M, Donnino R, Staniloae C, Robin T, Benenstein R, Vainrib A, Williams MR. Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient severe aortic stenosis in the setting of preserved left ventricular ejection fraction. J Interv Cardiol 2018; 31:849-860. [PMID: 30203608 DOI: 10.1111/joic.12561] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) for low gradient (LG) severe aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) remains an area of clinical uncertainty. METHODS Retrospective review identified 422 patients who underwent TAVR between September 4, 2014 and July 1, 2016. Procedural indication other than severe AS (n = 22) or LVEF <50% (n = 98) were excluded. Outcomes were defined by valve academic research consortium two criteria when applicable and compared between LG (peak velocity <4.0 m/s and mean gradient <40 mmHg; n = 73) and high gradient (HG) (n = 229) groups. The LG group was further categorized as low stroke volume index (SVI) (n = 41) or normal SVI (n = 32). Median follow-up was 747 days [interquartile range 220-1013]. RESULTS Baseline thirty-day mortality risk (LG 6.2% [3.8-8.1] vs HG 5.7% [4.1-7.4], P = 0.43) did not differ between groups. Short-term outcomes, including procedural success rate (86.1% vs 88.8%, P = 0.53), peri-procedural complications (intra-procedural heart block: 6.8% vs 7.9%, P = 0.99; permanent pacemaker placement: 11.0% vs 13.6%, P = 0.69; moderate paravalvular regurgitation: 2.7% vs 1.3%, P = 0.60), and all-cause in-hospital mortality (2.7% vs 0.9%, P = 0.25) did not differ between LG and HG groups. On long-term follow-up, all-cause mortality also did not differ between LG and HG groups (6.8% vs 10.0%, plog-rank = 0.33) or between the LG low SVI (9.8%), LG normal SVI (3.1%), and HG (10.0%) groups (plog-rank = 0.39). CONCLUSION Patients with preserved LVEF undergoing TAVR for severe AS with LG, including LG with low SVI, have no significant difference in adverse outcomes when compared to patients with HG.
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Affiliation(s)
- Binita Shah
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health System and New York University (NYU) School of Medicine, New York, New York
| | - Daniel McDonald
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Darien Paone
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Gabriel Redel-Traub
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Umair Jangda
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, NYU School of Medicine, New York, New York
| | - Muhamed Saric
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Robert Donnino
- Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health System and New York University (NYU) School of Medicine, New York, New York
| | - Cezar Staniloae
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Tonya Robin
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Ricardo Benenstein
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Alan Vainrib
- Department of Medicine, Division of Cardiology, NYU School of Medicine, New York, New York
| | - Mathew R Williams
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York
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114
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Dahou A, Clavel MA, Capoulade R, O’Connor K, Ribeiro HB, Côté N, Le Ven F, Rodés-Cabau J, Dumesnil JG, Mathieu P, Pibarot P. B-Type Natriuretic Peptide and High-Sensitivity Cardiac Troponin for Risk Stratification in Low-Flow, Low-Gradient Aortic Stenosis. JACC Cardiovasc Imaging 2018; 11:939-947. [DOI: 10.1016/j.jcmg.2017.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/09/2017] [Accepted: 06/21/2017] [Indexed: 10/18/2022]
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115
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Mihos CG, Klassen SL, Yucel E. Sex-Specific Considerations in Women with Aortic Stenosis and Outcomes After Transcatheter Aortic Valve Replacement. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:52. [PMID: 29923126 DOI: 10.1007/s11936-018-0651-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Aortic stenosis (AS) is the most common valvular disease in the elderly and is associated with poor outcomes. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement (SAVR) in high-risk patients. Herein, we describe the gender-related differences in baseline characteristics and pathophysiologic response to severe AS, imaging considerations unique to females, and short- and long-term outcomes after TAVR. Women undergoing TAVR are older and frailer, have less cardiovascular comorbidities, smaller femoral artery size, better left ventricular systolic function, hypertrophied and small left ventricles leading to a higher incidence of paradoxical low-flow low-gradient AS, and a greater prevalence of porcelain aorta, smaller aortic annulus size, and lower coronary ostia heights. Imaging and histopathological data also suggests a sex-related myocardial response to pressure overload from AS. Women experience more vascular complications and blood transfusion requirements, serious procedural complications, and a greater incidence of stroke, but have better long-term outcomes than men. Patient-prosthesis mismatch, which is a concern in patients with a small aortic annulus size undergoing SAVR, has not been problematic with TAVR. The aforementioned findings suggest that TAVR may be preferable for women with severe AS. Further studies are warranted to directly compare TAVR with SAVR in women.
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Affiliation(s)
- Christos G Mihos
- Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Sheila L Klassen
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 5B, Boston, MA, 02114, USA.
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Rosa VEE, Fernandes JRC, Lopes ASDSA, Sampaio RO, Tarasoutchi F. Paradoxical Aortic Stenosis: Simplifying the Diagnostic Process. Arq Bras Cardiol 2018; 110:484-486. [PMID: 29898047 PMCID: PMC5967143 DOI: 10.5935/abc.20180075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/24/2017] [Indexed: 11/20/2022] Open
Affiliation(s)
- Vitor Emer Egypto Rosa
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | | | | | - Roney Orismar Sampaio
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
| | - Flávio Tarasoutchi
- Instituto do Coração (InCor) - Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brazil
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117
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Cutting WB, Bavry AA. The evolving approach to the evaluation of low-gradient aortic stenosis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:197-201. [PMID: 29706476 DOI: 10.1016/j.carrev.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 11/18/2022]
Abstract
Severe aortic stenosis (AS) is typically identified by a low valve area (≤1.0 cm2) and high mean gradient (≥40 mm Hg). A subset of patients are found to have a less than severe mean gradient (<40 mm Hg) despite a low valve area. These latter types can present as either low ejection fraction with low-gradient AS (stage D2) or normal ejection fraction with low-gradient AS (stage D3). Determining the true severity of disease within these categories has proved difficult. In this review we illustrate both traditional and novel techniques that can be used for further valvular assessment. We also propose a simple algorithm that can be used to evaluate low-gradient AS.
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Affiliation(s)
- William B Cutting
- Department of Medicine, University of Florida, Gainesville, FL, United States
| | - Anthony A Bavry
- Department of Medicine, University of Florida, Gainesville, FL, United States; North Florida/South Georgia Veterans Health System, Gainesville, FL, United States.
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118
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Yousef A, Hibbert B, Feder J, Bernick J, Russo J, MacDonald Z, Glover C, Dick A, Boodhwani M, Lam BK, Ruel M, Labinaz M, Burwash IG. A novel echocardiographic hemodynamic index for predicting outcome of aortic stenosis patients following transcatheter aortic valve replacement. PLoS One 2018; 13:e0195641. [PMID: 29698407 PMCID: PMC5919479 DOI: 10.1371/journal.pone.0195641] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022] Open
Abstract
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. Methods A total of 258 patients with symptomatic severe AS (indexed aortic valve area (AVA)<0.6cm2/m2, AR≤2+) underwent successful TAVR at the University of Ottawa Heart Institute and had clinical follow-up to 1-year post-TAVR. Pre-TAVR MG, AVA, percent stroke work loss (%SWL), Zva and RVL were measured by echocardiography. The primary endpoint was all cause mortality at 1-year post TAVR. Results There were 53 deaths (20.5%) at 1-year. RVL≤7.95ml/m2 had a sensitivity of 60.4% and specificity of 75.1% for identifying all cause mortality at 1-year post-TAVR and provided better specificity than MG<40 mmHg, AVA>0.75cm2, %SWL≤25% and Zva>5mmHg/ml/m2 despite equivalent or better sensitivity. In multivariable Cox analysis, RVL≤7.95ml/m2 was an independent predictor of all cause mortality (HR 3.2, CI 1.8–5.9; p<0.0001). RVL≤7.95ml/m2 was predictive of all cause mortality in both low flow and normal flow severe AS. Conclusions RVL is a strong predictor of all-cause mortality in severe AS patients undergoing TAVR. A pre-procedural RVL≤7.95ml/m2 identifies AS patients at increased risk of death despite TAVR and may assist with decision making on the benefits of TAVR.
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Affiliation(s)
- Altayyeb Yousef
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Joshua Feder
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jordan Bernick
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Juan Russo
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Zachary MacDonald
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Glover
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Alexander Dick
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Munir Boodhwani
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Buu-Khanh Lam
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian G. Burwash
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
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119
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Hahn RT, Nicoara A, Kapadia S, Svensson L, Martin R. Echocardiographic Imaging for Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2018; 31:405-433. [DOI: 10.1016/j.echo.2017.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 02/06/2023]
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120
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ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease. J Am Soc Echocardiogr 2018; 31:381-404. [DOI: 10.1016/j.echo.2017.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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121
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Clavel MA, Guzzetti E, Annabi MS, Salaun E, Ong G, Pibarot P. Normal-Flow Low-Gradient Severe Aortic Stenosis: Myth or Reality? STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2018.1437934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Géraldine Ong
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Abstract
PURPOSE OF REVIEW Transcatheter aortic valve replacement (TAVR) is underpinned by an array of imaging techniques designed to not only select an appropriately sized implant but also to identify potential obstacles to procedural success. This review presents currently important aspects of TAVR imaging, describing the salient features of each modality as well as recent developments in the field. RECENT FINDINGS The latest data on TAVR outcomes reflects the increasing experience of operators and the significant role of pre-procedural imaging. Debate continues as to which modality sizes the aortic annulus most accurately, 3D transoesophageal echocardiography (TEE) or MDCT, as well as to whether the merits of real-time peri-procedural 3D imaging guidance outweigh the possible adverse consequences of general anaesthesia which is requisite for intraprocedural 3D TEE. TAVR is now largely based on pre-acquired roadmaps of the truncal vasculature and intense pre-procedural planning. TEE and Multi-detector computed tomography (MDCT) have been shown to perform similarly in annulus sizing. However, given the complexity of many TAVR patients and the importance of identifying the most suitable pathway to the valve as well as any potentially confounding other structural or functional heart disease, both modalities remain relevant in current TAVR.
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123
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Argulian E, Seetharam K. Echocardiographic 3D-guided 2D planimetry in quantifying left-sided valvular heart disease. Echocardiography 2018; 35:695-706. [PMID: 29420834 DOI: 10.1111/echo.13828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Echocardiographic 3D-guided 2D planimetry can improve the accuracy of valvular disease assessment. Acquisition of 3D pyramidal dataset allows subsequent multiplanar reconstruction with accurate orthogonal plane alignment to obtain the correct borders of an anatomic orifice or flow area. Studies examining the 3D-guided 2D planimetry approach in left-sided valvular heart disease were identified and reviewed. The strongest evidence exists for estimating mitral valve area in patients with rheumatic mitral valve stenosis and vena contracta area in patients with mitral regurgitation (both primary and secondary). 3D-guided approach showed excellent feasibility and reproducibility in most studies, as well as time efficiency and good correlation with reference and comparator methods. Therefore, 3D-guided 2D planimetry can be used as an important clinical tool in quantifying left-sided valvular heart disease, especially mitral valve disorders.
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Ong G, Clavel MA, Pibarot P. Concomitant mitral regurgitation: an insidious cause of lowflow, low-gradient severe aortic stenosis. EUROINTERVENTION 2018; 13:1622-1625. [DOI: 10.4244/eijv13i14a261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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125
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Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Nucl Cardiol 2017; 24:2043-2063. [PMID: 29067561 DOI: 10.1007/s12350-017-1070-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This document is 1 of 2 companion appropriate use criteria (AUC) documents developed by the American College of Cardiology, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. This document addresses the evaluation and use of multimodality imaging in the diagnosis and management of valvular heart disease, whereas the second, companion document addresses this topic with regard to structural heart disease. Although there is clinical overlap, the documents addressing valvular and structural heart disease are published separately, albeit with a common structure. The goal of the companion AUC documents is to provide a comprehensive resource for multimodality imaging in the context of valvular and structural heart disease, encompassing multiple imaging modalities.Using standardized methodology, the clinical scenarios (indications) were developed by a diverse writing group to represent patient presentations encountered in everyday practice and included common applications and anticipated uses. Where appropriate, the scenarios were developed on the basis of the most current American College of Cardiology/American Heart Association guidelines.A separate, independent rating panel scored the 92 clinical scenarios in this document on a scale of 1 to 9. Scores of 7 to 9 indicate that a modality is considered appropriate for the clinical scenario presented. Midrange scores of 4 to 6 indicate that a modality may be appropriate for the clinical scenario, and scores of 1 to 3 indicate that a modality is considered rarely appropriate for the clinical scenario.The primary objective of the AUC is to provide a framework for the assessment of these scenarios by practices that will improve and standardize physician decision making. AUC publications reflect an ongoing effort by the American College of Cardiology to critically and systematically create, review, and categorize clinical situations where diagnostic tests and procedures are utilized by physicians caring for patients with cardiovascular diseases. The process is based on the current understanding of the technical capabilities of the imaging modalities examined.
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Affiliation(s)
| | - Smadar Kort
- American Society of Echocardiography, Morrisville, NC, USA
| | - Roxana Mehran
- Society for Cardiovascular Angiography and Interventions, Washington, DC, USA
| | | | - Prem Soman
- American Society of Nuclear Cardiology, Bethesda, MD, USA
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Sherwood MW, Kiefer TL. Challenges in Aortic Valve Stenosis: Low-Flow States Diagnosis, Management, and a Review of the Current Literature. Curr Cardiol Rep 2017; 19:130. [DOI: 10.1007/s11886-017-0941-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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127
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Dweck MR, Everett RJ. Multibiomarker Strategies in Aortic Stenosis. JACC Cardiovasc Imaging 2017; 11:948-950. [PMID: 28917694 DOI: 10.1016/j.jcmg.2017.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/13/2017] [Indexed: 01/09/2023]
Affiliation(s)
- Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Russell J Everett
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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Affiliation(s)
- Philippe Pibarot
- From the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Laval University, Québec, Canada
| | - Marie-Annick Clavel
- From the Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Laval University, Québec, Canada
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Kusunose K, Yamada H, Nishio S, Torii Y, Hirata Y, Seno H, Saijo Y, Ise T, Yamaguchi K, Yagi S, Soeki T, Wakatsuki T, Sata M. Preload Stress Echocardiography Predicts Outcomes in Patients With Preserved Ejection Fraction and Low-Gradient Aortic Stenosis. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006690. [DOI: 10.1161/circimaging.117.006690] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 08/10/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Kenya Kusunose
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Hirotsugu Yamada
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Susumu Nishio
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Yuta Torii
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Yukina Hirata
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Hiromitsu Seno
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Yoshihito Saijo
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Takayuki Ise
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Koji Yamaguchi
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Shusuke Yagi
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Takeshi Soeki
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Tetsuzo Wakatsuki
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
| | - Masataka Sata
- From the Department of Cardiovascular Medicine (K.K., H.Y., H.S., Y.S., T.I., K.Y., S.Y., T.S., T.W., M.S.) and Ultrasound Examination Center (S.N., Y.T., Y.H.), Tokushima University Hospital, Japan
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ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 2017; 70:1647-1672. [PMID: 28870679 DOI: 10.1016/j.jacc.2017.07.732] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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131
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Abstract
Transcatheter aortic valve implantation (TAVI) has proven to be the standard of care for patients with prohibitive and high operative risk; today, it is considered a reasonable alternative to surgical aortic valve replacement in intermediate-risk patients. As indications for TAVI move toward patients at lower risk, safety aspects are becoming even more important. Furthermore, adequate patient selection is key for predictable procedural success with minimal complications, translating into an optimal clinical outcome. Decisions on valve type and size as well as on the access route are based on multimodality imaging including echocardiography, multislice computed tomography, and cardiac catheterization with peripheral angiography. This combination of multiple imaging modalities provides the best picture of a patient's anatomical and physiological suitability for the TAVI procedure. Yet, the reliability of preprocedural imaging is influenced by the quality of the images, which should be as high as possible, and both image acquisition and interpretation should be performed in a standardized manner. This article provides a concise overview of standardized multimodality imaging for the preprocedural planning and assessment of patients undergoing TAVI.
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Abstract
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.
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133
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Aortic Stenosis Is Still Very Tricky, Especially When it Is Moderate. J Am Coll Cardiol 2017; 69:2393-2396. [PMID: 28494977 DOI: 10.1016/j.jacc.2017.03.569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/27/2017] [Indexed: 12/21/2022]
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