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Velders BJJ, Groenwold RHH, Ajmone Marsan N, Kappetein AP, Wijngaarden RAFDLV, Braun J, Klautz RJM, Vriesendorp MD. Improving accuracy in diagnosing aortic stenosis severity: An in-depth analysis of echocardiographic measurement error through literature review and simulation study. Echocardiography 2023; 40:892-902. [PMID: 37519290 DOI: 10.1111/echo.15664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/10/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS The present guidelines advise replacing the aortic valve for individuals with severe aortic stenosis (AS) based on various echocardiographic parameters. Accurate measurements are essential to avoid misclassification and unnecessary interventions. The objective of this study was to evaluate the influence of measurement error on the echocardiographic evaluation of the severity of AS. METHODS AND RESULTS A systematic review was performed to examine whether measurement errors are reported in studies focusing on the prognostic value of peak aortic jet velocity (Vmax ), mean pressure gradient (MPG), and effective orifice area (EOA) in asymptomatic patients with AS. Out of the 37 studies reviewed, 17 (46%) acknowledged the existence of measurement errors, but none of them utilized methods to address them. Secondly, the magnitude of potential errors was collected from available literature for use in clinical simulations. Interobserver variability ranged between 0.9% and 8.3% for Vmax and MPG but was higher for EOA (range 7.7%-12.7%), indicating lower reliability. Assuming a circular left ventricular outflow tract area led to a median underestimation of EOA by 23% compared to planimetry by other modalities. A clinical simulation resulted in the reclassification of 42% of patients, shifting them from a diagnosis of severe AS to moderate AS. CONCLUSIONS Measurement errors are underreported in studies on echocardiographic assessment of AS severity. These errors can lead to misclassification and misdiagnosis. Clinicians and scientists should be aware of the implications for accurate clinical decision-making and assuring research validity.
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Affiliation(s)
- Bart J J Velders
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Rolf H H Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arie-Pieter Kappetein
- Global Clinical Operations, Coronary and Structural Heart, Medtronic, Maastricht, The Netherlands
| | | | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel D Vriesendorp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
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2
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Sagmeister F, Herrmann S, Gassenmaier T, Bernhardt P, Rasche V, Liebold A, Weidemann F, Brunner H, Beer M. Non-invasive determination of pressure recovery by cardiac MRI and echocardiography in patients with severe aortic stenosis: short and long-term outcome prediction. J Int Med Res 2020; 48:300060520954708. [PMID: 33076730 PMCID: PMC7592334 DOI: 10.1177/0300060520954708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the influence of pressure recovery (PR)-corrected haemodynamic parameters on outcome in patients with aortic stenosis. METHODS Aortic stenosis severity parameters were corrected for PR (increase in static pressure due to decreasing dynamic pressure), assessed using transthoracic echocardiography (TTE) or cardiac magnetic resonance imaging (CMR), in patients with aortic stenosis. PR, indexed PR (iPR) and energy loss index (ELI) were determined. Factors that predicted all-cause mortality, and 9-month or 10-year New York Heart Association classification ≥2 were assessed using Cox proportional hazards regression. RESULTS A total of 25 patients, aged 68 ± 10 years, were included. PR was 17 ± 6 mmHg using CMR, and CMR correlated with TTE measurements. PR correction using CMR data reduced the AS-severity classification in 12-20% of patients, and correction using TTE data reduced the AS-severity classification in 16% of patients. Age (Wald 4.774) was a statistically significant predictor of all-cause mortality; effective orifice area (Wald 3.753) and ELI (Wald 3.772) almost reached significance. CONCLUSIONS PR determination may result in significant reclassification of aortic stenosis severity and may hold value in predicting all-cause mortality.
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Affiliation(s)
- Florian Sagmeister
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sebastian Herrmann
- Department of Medicine I, Division of Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Volker Rasche
- Department of Medicine II, Cardiology, University Hospital Ulm, Ulm, Germany
| | - Andreas Liebold
- Department of Cardiac, Thoracic and Vascular Surgery, University Hospital Ulm, Ulm, Germany
| | - Frank Weidemann
- Department of Medicine I, Division of Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Medicine I, Hospital Centre Vest, Recklinghausen, Germany
| | - Horst Brunner
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
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3
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Norum IB, Edvardsen T, Ruddox V, Gunther A, Dahle G, Otterstad JE. Three-dimensional versus two-dimensional transthoracic echocardiography for left ventricular outflow tract measurements in severe aortic stenosis. A cross-sectional study using computer tomography and Haegar sizers as reference. SCAND CARDIOVASC J 2020; 54:220-226. [PMID: 32408833 DOI: 10.1080/14017431.2020.1761559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives. In grading of aortic stenosis, two-dimensional transthoracic echocardiography (2D TTE) routinely results in underestimation of the left ventricular outflow tract (LVOT) area, and hence the aortic valve area (AVA). We investigated whether three-dimensional (3D) TTE measurements of the LVOT would be more accurate. We evaluated the feasibility, agreement and inter-observer variability of 3D TTE LVOT measurements with computed tomography (CT) and Haegar sizers as reference. Design. Sixty-one patients with severe aortic stenosis were examined with 2D and 3D TTE. 41 had CT and 13 also had perioperative Haegar sizing. Pearson's correlation and Bland-Altman plots were used to compare methods. Inter-observer variability was tested for 2D and 3D TTE. Trial registration: Current research information system in Norway (CRISTIN). Id: 555249. Results. Feasibility was 67% with 3D TTE and 100% with 2D TTE and CT. Mean LVOT area for 2D, 3D, CT and Haegar sizers were 3.7 ± 0.6 cm2, 4.0 ± 0.9 cm2, 5.2 ± 0.8 cm2 and 4.4 ± 1.0 cm2 respectively. Bias and limits of agreements for 2D TTE was 1.5 ± 1.3 cm2, compared with CT and 0.4 ± 1.5 cm2 with Haegar sizers. Corresponding results for 3D TTE were 1.2 ± 1.6 cm2 and 0.2 ± 1.8 cm2. Intraclass correlation coefficients for LVOT area were 0.62 for 3D and 0.86 for 2D. Conclusions. 2D TTE showed better feasibility and inter-observer variability in measurements of LVOT than 3D TTE. Both echocardiographic methods underestimated LVOT area compared to CT and Haegar sizers. These observations suggest that 2D TTE is still preferable to 3D TTE in the assessment of aortic stenosis.
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Affiliation(s)
- Ingvild Billehaug Norum
- Department of Cardiology, Vestfold Hospital trust, Tonsberg, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Thor Edvardsen
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Vidar Ruddox
- Department of Cardiology, Vestfold Hospital trust, Tonsberg, Norway
| | - Anne Gunther
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Radiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Gry Dahle
- Department of Cardiothoracic surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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4
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Alskaf E, Gupta T, Kardos A. Aortic valve area using computed tomography-derived correction factor to improve the validity of left ventricular outflow tract measurements. Echocardiography 2020; 37:196-206. [PMID: 32003912 DOI: 10.1111/echo.14601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 11/27/2022] Open
Abstract
AIMS Given the inherent inaccuracies stemming from the assumption that the left ventricular outflow tract (LVOT) is circular, this study aimed to improve the accuracy of transthoracic echocardiography (TTE)-based aortic valve area (AVA) calculation using continuity equation (CE) by introducing a correction factor (CF) derived from multidetector computed tomography angiography (MDCTA) images and validate it in aortic stenosis (AS) patients. METHODS AND RESULTS This retrospective study used MDCTA images of 400 patients for modeling and 403 TTE dataset for validation. Echocardiographic parasternal long-axis view was modeled using MDCTA, and LVOT diameter (D1) was measured. Direct planimetry of LVOT area was performed and subsequently converted into a theoretical circle. The assumed circle (D2) diameter was derived, and D2/D1 was calculated and termed as the CF. The CF was 1.13, and it improved the agreement between MDCTA- and TTE-derived LVOT areas and correlation between AVA and peak velocity, mean pressure gradient, and velocity ratio. In discordant subgroups of severe AS, the CF reclassified patients to moderate AS in 40% in the low flow (LF), low gradient (LG), and low ejection fraction (EF) group; 53% in the LF, LG, and normal EF group; and 68% in the LF, high gradient, and normal EF group. CONCLUSIONS CF of 1.13 derived from MDCTA improved the accuracy of TTE-derived LVOT area and AVA and improved correlation with hemodynamic variables in AS patients. Reclassification of AS patients using CF may have clinical applicability for patient selection for early intervention.
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Affiliation(s)
- Ebraham Alskaf
- Cardiology Department, Milton Keynes University Hospitals, Eaglestone, Milton Keynes, UK
| | - Tarun Gupta
- Cardiology Department, Milton Keynes University Hospitals, Eaglestone, Milton Keynes, UK
| | - Attila Kardos
- Cardiology Department, Milton Keynes University Hospitals, Eaglestone, Milton Keynes, UK.,School of Sciences and Medicine, University of Buckingham, Buckingham, UK
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5
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Rong LQ, Hameed I, Salemi A, Rahouma M, Khan FM, Wijeysundera HC, Angiolillo DJ, Shore-Lesserson L, Biondi-Zoccai G, Girardi LN, Fremes SE, Gaudino M. Three-Dimensional Echocardiography for Transcatheter Aortic Valve Replacement Sizing: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2019; 8:e013463. [PMID: 31549579 PMCID: PMC6806040 DOI: 10.1161/jaha.119.013463] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Transcatheter aortic valve replacement (TAVR) is the standard of care for many patients with severe symptomatic aortic stenosis and relies on accurate sizing of the aortic annulus. It has been suggested that 3‐dimensional transesophageal echocardiography (3D TEE) may be used instead of multidetector computed tomography (MDCT) for TAVR planning. This systematic review and meta‐analysis compared 3D TEE and MDCT for pre‐TAVR measurements. Methods and Results A systematic literature search was performed. The primary outcome was the correlation coefficient between 3D TEE– and MDCT‐measured annular area. Secondary outcomes were correlation coefficients for mean annular diameter, annular perimeter, and left ventricular outflow tract area; interobserver and intraobserver agreements; mean differences between 3D TEE and MDCT measurements; and pooled sensitivities, specificities, and receiver operating characteristic area under curve values of 3D TEE and MDCT for discriminating post‐TAVR paravalvular aortic regurgitation. A random effects model was used. Meta‐regression and leave‐one‐out analysis for the primary outcome were performed. Nineteen studies with a total of 1599 patients were included. Correlations between 3D TEE and MDCT annular area, annular perimeter, annular diameter, and left ventricular outflow tract area measurements were strong (0.86 [95% CI, 0.80–0.90]; 0.89 [CI, 0.82–0.93]; 0.80 [CI, 0.70–0.87]; and 0.78 [CI, 0.61–0.88], respectively). Mean differences between 3D TEE and MDCT between measurements were small and nonsignificant. Interobserver and intraobserver agreement and discriminatory abilities for paravalvular aortic regurgitation were good for both 3D TEE and MDCT. Conclusions For pre‐TAVR planning, 3D TEE is comparable to MDCT. In patients with renal dysfunction, 3D TEE may be potentially advantageous for TAVR measurements because of the lack of contrast exposure.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology Weill Cornell Medicine New York NY
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
| | - Arash Salemi
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
| | - Faiza M Khan
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
| | | | | | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies Sapienza University of Rome Latina Italy.,Mediterranea Cardiocentro Napoli Italy
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
| | - Stephen E Fremes
- Schulich Heart Centre Sunnybrook Health Science University of Toronto Canada
| | - Mario Gaudino
- Department of Cardiothoracic Surgery Weill Cornell Medicine New York NY
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6
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The mystery of defining aortic valve area: what have we learnt from three-dimensional imaging modalities? J Echocardiogr 2018; 16:130-138. [PMID: 29476387 DOI: 10.1007/s12574-018-0374-8] [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: 10/25/2017] [Revised: 01/23/2018] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
Abstract
Aortic valve area is one of the main criteria used by echocardiography to determine the degree of valvular aortic stenosis, and it is calculated using the continuity equation which assumes that the flow volume of blood is equal at two points, the aortic valve area and the left ventricular outflow tract (LVOT). The main fallacy of this equation is the assumption that the LVOT area which is used to calculate the flow volume at the LVOT level is circular, where it is often an ellipse and sometimes irregular. The aim of this review is to explain the physiology of the continuity equation, the different sources of errors, the added benefits of using three-dimensional imaging modalities to measure LVOT area, the latest recommendations related to valvular aortic stenosis, and to introduce future perspectives. A literature review of studies comparing aortic valve area and LVOT area, after using three-dimensional data, has shown underestimation of both measurements when using the continuity equation. This has more impact on patients with discordant echocardiographic measurements when aortic valve area is disproportionate to haemodynamic measurements in assessing the degree of aortic stenosis. Although fusion imaging modalities of LVOT area can help in certain group of patients to address the issue of aortic valve area underestimation, further research on introducing a correction factor to the conventional continuity equation might be more rewarding, saving patients additional tests and potential radiation, with no clear evidence of cost-effectiveness.
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7
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Barletta G, Venditti F, Stefano P, Del Bene R, Di Mario C. Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis. Echocardiography 2017; 35:329-336. [DOI: 10.1111/echo.13778] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Giuseppe Barletta
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Francesco Venditti
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Pierluigi Stefano
- Cardiac Surgery, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Riccarda Del Bene
- Cardiology Diagnostics, Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology Division; Cardiac, Thoracic & Vascular Department; University Hospital Careggi; Florence Italy
- National Institute for Health Research (NIHR) Biomedical Research Unit; Royal Brompton & Harefield NHS Foundation Trust; London UK
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8
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Impact of stroke volume assessment by integrating multi-detector computed tomography and Doppler data on the classification of aortic stenosis. Int J Cardiol 2017; 246:80-86. [DOI: 10.1016/j.ijcard.2017.03.112] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 01/15/2023]
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9
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Affiliation(s)
- Alexander Gotschy
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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10
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Binter C, Gotschy A, Sündermann SH, Frank M, Tanner FC, Lüscher TF, Manka R, Kozerke S. Turbulent Kinetic Energy Assessed by Multipoint 4-Dimensional Flow Magnetic Resonance Imaging Provides Additional Information Relative to Echocardiography for the Determination of Aortic Stenosis Severity. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005486. [PMID: 28611119 DOI: 10.1161/circimaging.116.005486] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/21/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Christian Binter
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Alexander Gotschy
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Simon H. Sündermann
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Michelle Frank
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Felix C. Tanner
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Thomas F. Lüscher
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Robert Manka
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
| | - Sebastian Kozerke
- From the Institute for Biomedical Engineering, University and ETH Zurich, Switzerland (C.B., A.G., S.K.); Department of Cardiology, University Heart Center (A.G., M.F., F.C.T., T.F.L., R.M.), Division of Internal Medicine (A.G.), and Institute of Diagnostic and Interventional Radiology (R.M.), University Hospital Zurich, Switzerland; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Germany (S.H.S.); and Imaging Sciences and Biomedical Engineering, King’s College
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11
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Deeprasertkul P, Ahmad M. Evolving new concepts in the assessment of aortic stenosis. Echocardiography 2017; 34:731-745. [PMID: 28345156 DOI: 10.1111/echo.13501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
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. Specifically, we will address the hemodynamic characteristics, clinical presentation, and management of normal-flow, high-gradient; paradoxical low-flow, low-gradient; and classical low-flow, low-gradient aortic stenoses.
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Affiliation(s)
| | - Masood Ahmad
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA
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