Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis

Galián-Gay, Laura; Teixidó-Turà, Gisela; Casas, G; Ferrer-Sistach, Elena; Mitroi, Cristina; Mingo, Susana; Moñivas, Vanessa; Saura, Daniel; Vidal, Bárbara; Moral, Sergio; Calvo, Francisco; Sánchez, Violeta; González, Ariana; Guzmán‐Martínez, Gabriela; Mora, Marta Noris; Vives, Miguel A. Arnau; Peteiro, Jesús; Bouzas, Alberto; González‐Alujas, Teresa; Gutiérrez, Laura; Fernandez-Galera, R; Valente, Filipa; Guala, Andrea; Ruiz-Muñoz, Aroa; Dux-Santoy, Lydia; Soldevila, Ruper Oliveró; Avilés, Augusto Sao; Palomares, José F. Rodríguez; Ferreira‐González, Ignacio; Evangelista, Artur

doi:10.1093/ehjci/jead067

Cited by 2 publications

(1 citation statement)

References 30 publications

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“…In these cases, the SV reduction is related to an accentuated concentric remodeling that generates a small left ventricular cavity. Alterations in diastolic function and decrease in myocardial deformity (longitudinal strain), a finding that indicates an incipient alteration in systolic function [ 75 ], are common. This subgroup of AS has many pathophysiological similarities with heart failure with preserved LVEF and, from a clinical point of view, both are associated with a similar patient profile: advanced age, female sex, and hypertension.…”

Section: Use Of Multimodality Cardiac Imaging In Challenging Casesmentioning

confidence: 99%

Diagnostic Challenges in Aortic Stenosis

González-García,

Pazos-López,

Calvo-Iglesias

et al. 2024

JCDD

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Aortic stenosis (AS) is the most prevalent degenerative valvular disease in western countries. Transthoracic echocardiography (TTE) is considered, nowadays, to be the main imaging technique for the work-up of AS due to high availability, safety, low cost, and excellent capacity to evaluate aortic valve (AV) morphology and function. Despite the diagnosis of AS being considered straightforward for a very long time, based on high gradients and reduced aortic valve area (AVA), many patients with AS represent a real dilemma for cardiologist. On the one hand, the acoustic window may be inadequate and the TTE limited in some cases. On the other hand, a growing body of evidence shows that patients with low gradients (due to systolic dysfunction, concentric hypertrophy or coexistence of another valve disease such as mitral stenosis or regurgitation) may develop severe AS (low-flow low-gradient severe AS) with a similar or even worse prognosis. The use of complementary imaging techniques such as transesophageal echocardiography (TEE), multidetector computed tomography (MDTC), or cardiac magnetic resonance (CMR) plays a key role in such scenarios. The aim of this review is to summarize the diagnostic challenges associated with patients with AS and the advantages of a comprehensive multimodality cardiac imaging (MCI) approach to reach a precise grading of the disease, a crucial factor to warrant an adequate management of patients.

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Section: Use Of Multimodality Cardiac Imaging In Challenging Casesmentioning

confidence: 99%

Diagnostic Challenges in Aortic Stenosis

González-García,

Pazos-López,

Calvo-Iglesias

et al. 2024

JCDD

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Randomised study for the Optimal Treatment of symptomatic patients with low-gradient severe Aortic valve Stenosis and preserved left ventricular ejection fraction (ROTAS trial)

Galli,

Le Ven,

Coisne

et al. 2024

Heart

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BackgroundThe best management of symptomatic patients with low-gradient (LG) severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) has not been established. The Randomised study for the Optimal Treatment of symptomatic patients with low-gradient severe Aortic valve Stenosis (ROTAS) trial aimed to assess the superiority of aortic valve replacement (AVR) versus medical treatment (MT) in this specific group of AS patients.MethodsPatients with symptomatic LG severe AS and preserved LVEF (>50%) underwent dobutamine stress echocardiography and/or CT-aortic calcium score to confirm AS severity and were then randomised 1:1 to AVR or MT. The primary endpoint was a composite of overall death and/or cardiovascular hospitalisation.ResultsThe ROTAS study was stopped early because of insufficient recruitment. In the end, only 52 patients (age 79±7 years; women 54%; NYHA III-IV 27%; median STS score 3.3%) were included in the study. During follow-up (mean: 14±7 months), the primary endpoint occurred in 12 (23%) patients. Compared with MT, AVR was not associated with a significant prognostic benefit (events: 5/26 (19%) vs 7/26 (27%) (HR 0.76, 95% CI 0.24 to 2.39, p=0.63). During follow-up, 11 (42%) patients in the MT group developed class I criteria for AVR or severe symptoms justifying a cross-over to the AVR group.ConclusionsBecause of the small number of included patients and short follow-up the ROTAS trial was underpowered and unable to demonstrate a difference in the study endpoint between treatment arms. In patients in the MT arm, a regular echocardiographic and clinical assessment might be useful to disclose those developing class I indications of AVR or severe AS-related symptoms.Trial registration numberNCT01835028.

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Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis

Cited by 2 publications

References 30 publications

Diagnostic Challenges in Aortic Stenosis

Diagnostic Challenges in Aortic Stenosis

Randomised study for the Optimal Treatment of symptomatic patients with low-gradient severe Aortic valve Stenosis and preserved left ventricular ejection fraction (ROTAS trial)

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