Changes in effective aortic valve area during ejection in adults with aortic stenosis

Badano, Luigi P.; Cassottana, Paolo; Bertoli, Daniele; Carratino, L; Lucatti, A; Spirito, Paolo

doi:10.1016/s0002-9149(96)00528-0

Cited by 20 publications

(7 citation statements)

References 25 publications

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“…A previous study of valve dynamics in patients with aortic stenosis found no relationship between the magnitude of change in effective AVA measured during ejection and the usual indices of aortic stenosis severity, such as AVA measured at peak transaortic flow velocity. 7 Our results indicate that a more detailed evaluation of AVA can provide additional insight into the severity of aortic stenosis.…”

Section: Relationship Between Ava Ratio and Aortic Stenosis Progressionmentioning

confidence: 58%

“…Although any number of time points could have been chosen, we chose 1/2 a and 1/2 d because these were the time points used in previous studies that described aortic valve dynamics measured with Doppler echocardiography. 7,10 The AVA ratio was defined as AVA (1/2 d )/AVA (1/2 a ). The rate of change in AVA during ejection will directly affect the AVA ratio.…”

Section: Ava Ratiomentioning

confidence: 99%

“…A valve, which opens and closes slowly, will have a smaller value for AVA (1/2 a ) and a larger value for AVA (1/2 d ) compared with the AVA measured at peak velocity, which will therefore have a larger AVA ratio. An explanation for why the AVA is largest at Md when flow velocity has decreased was proposed by Badano et al, 7 who suggested that the kinetic energy required to initiate motion in calcified and stiff valve is significantly more than that required to further move the valve once it is in motion. In addition, given a constant flow, the flow velocity through a smaller orifice may be greater than that through a larger orifice.…”

Section: Ava Ratiomentioning

confidence: 99%

“…When aortic valve dynamics have been evaluated in patients with valvular aortic stenosis, it has been shown that the valve opens and closes more slowly than structurally normal valves. 6,7 In addition, there appears to be no relationship between the rate of change in valve area during ejection and the usual indices of stenosis severity, such as AVA measured at peak velocity. 7 Therefore, 2 patients with the same AVA, measured at peak velocity, may have very different valve dynamics.…”

mentioning

confidence: 99%

“…6,7 In addition, there appears to be no relationship between the rate of change in valve area during ejection and the usual indices of stenosis severity, such as AVA measured at peak velocity. 7 Therefore, 2 patients with the same AVA, measured at peak velocity, may have very different valve dynamics. Although the maximum AVAs may be the same, a patient with a slower rate of change in valve area would have proportionately less time during ejection when the valve is maximally open and therefore the ventricle is more burdened by what may be considered more severe stenosis.…”

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confidence: 99%

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Rate of Change in Aortic Valve Area During a Cardiac Cycle Can Predict the Rate of Hemodynamic Progression of Aortic Stenosis

et al. 2000

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Background-The ability to predict the rate of hemodynamic progression in an individual patient with valvular aortic stenosis has been elusive. The purpose of the present study was to evaluate whether the rate of change in aortic valve area (AVA) measured during the ejection phase of a cardiac cycle predicts the rate of hemodynamic progression in patients with asymptomatic aortic stenosis. Methods and Results-In 84 adults with initially asymptomatic aortic stenosis and a baseline AVA of Ն0.9 cm 2 , annual echocardiographic data were obtained prospectively (mean follow-up 2.8Ϯ1.3 years). With the initial echocardiogram, the ratio of AVA measured at mid-acceleration and mid-deceleration to the AVA at peak velocity was calculated. The primary outcome variable was the annual rate of change in AVA (rate of progression), with rate of progression classified as rapid (a reduction in AVA of Ն0.2 cm 2 /y) or slow (Ͻ0.2 cm 2 /y). Rapid progression was significantly associated with an AVA ratio of Ն1.25 (Pϭ0.004, risk ratio 3.1, 95% CI 1.2 to 7.9). The sensitivity, specificity, and positive predictive value of AVA ratio of Ն1.25 for the prediction of rapid progression of valvar aortic stenosis was 64%, 72%, and 80% respectively. The decrease in ejection fraction measured from the initial to final echocardiogram was small but greater for patients with an AVA ratio of Ն1.25 (Ϫ4Ϯ7% versus ϩ2Ϯ7%, PϽ0.001). Conclusions-A flow-dependent change in AVA can be measured during a routine transthoracic echocardiographic study.The rate of change in AVA is an additional measure of disease severity and may be used to predict an individual's risk for subsequent rapid disease progression.

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Section: Relationship Between Ava Ratio and Aortic Stenosis Progressionmentioning

confidence: 58%

Section: Ava Ratiomentioning

confidence: 99%

Section: Ava Ratiomentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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