Effect of age and aortic valve anatomy on calcification and haemodynamic severity of aortic stenosis

Shen, Mylène; Tastet, Lionel; Capoulade, Romain; Larose, Éric; Bédard, Élisabeth; Arsenault, Marie; Chétaille, Philippe; Dumesnil, Jean G.; Mathieu, Patrick; Clavel, Marie‐Annick; Pîbarot, Philippe

doi:10.1136/heartjnl-2016-309665

Cited by 52 publications

(35 citation statements)

References 36 publications

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“…To this effect, it has recently been reported that MDCT may underestimate the hemodynamic severity of AS, especially in younger patients with bicuspid valves. 23 In summary, there is no gold-standard modality for quantitating AS severity. Each modality has strengths and limitations that need to be recognized and integrated in the interpretation of the various parameters measured with these modalities.…”

Section: Other Alternative Methods To Grade As Severitymentioning

confidence: 99%

Doppler Echocardiographic Quantitation of Aortic Valve Stenosis: A Science in Constant Evolution

Clavel

2016

Journal of the American Society of Echocardiography

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a steady pharmacologic effect. The flow rate versus mean gradient graph can be extrapolated to assess the hemodynamics of AS severity expected for the patient's age and exercise capacity. When flow rates at levels of activities or expected heart rate increase, resulting in a mean gradient in excess of 40 mm Hg, the patient's symptoms may be indicative of severe AS. The peak effort to symptom development in elderly patients past age 70 years may occur at heart rates lower than in younger patients. Thus, the flow rates occurring with spontaneous activity in elderly sedentary patients may be lower than in younger patients. This type of correction may be based on patients' activity levels. This approach circumvents the need to calculate projected AVA at different flow rates. In essence, AVA in severe calcific AS is nearly always fixed. The clinical question in elderly patients being considered for transcatheter aortic valve replacement is whether the symptoms are based on severe AS or other comorbidities. FUTURE NEEDS Anatomic valve area in mitral stenosis is often measured using echocardiographic approaches, more accurately with three-dimensional echocardiography. The use of quantitative approaches using realtime three-dimensional echocardiography to assess anatomic AVA must be investigated carefully, even though at the present time, a gold standard for true anatomic AVA is lacking.

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Section: Other Alternative Methods To Grade As Severitymentioning

confidence: 99%

Doppler Echocardiographic Quantitation of Aortic Valve Stenosis: A Science in Constant Evolution

Clavel

2016

Journal of the American Society of Echocardiography

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“…It is important to note that MDCT grossly underestimates valve fibrosis and hence significantly underestimates severe AS in younger patients [39]. Hence this technique may be used in older patients where the degenerative aortic valve pathology is driven by valve calcification.…”

Section: Ct Calcium Score Of the Aortic Valvementioning

confidence: 99%

Low Flow Low Gradient Severe Aortic Stenosis: Diagnosis and Treatment

Ali¹,

Wilson²,

Nair³

2019

Aortic Stenosis - Current Perspectives

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Approximately 40% of patients with aortic stenosis (AS) show discordant Doppler-echocardiographic parameters with aortic valve area (AVA) <1 cm 2 and/or index iAVA <0.6 cm 2 /m 2 (consistent with severe AS) and the mean gradient (MG) <40 mmHg, consistent with mild/moderate AS. Accurate diagnosis of true severe low flow low gradient AS versus pseudo-severe aortic stenosis is important for prognosis and optimal timing for intervention. Doppler echocardiography using intravenous low dose dobutamine challenge is widely used for differentiating pseudo-severe from true severe aortic stenosis. However, relying on echocardiography alone may have limitations in accurate diagnosis. Reliable diagnosis using echocardiography is dependent on multiple factors like the angle of interrogation of the aortic jet, the assumption that the LVOT area is circular in cross section, optimal echo windows, the presence of underlying subclinical coronary artery disease prior to dobutamine challenge etc. In this chapter, we describe non-invasive and invasive strategies to assess the aortic valve using dobutamine stress. Direct measurement of gradients across the aortic valve while estimating the change in cardiac output and aortic valve area with increments of dobutamine infusion dose is complementary, safe and useful when conventional echocardiography techniques are inconclusive. Finally, the chapter describes effective strategies of treatment for low gradient severe aortic stenosis, including the role for diagnostic balloon valvuloplasty, in the era of transcatheter valve replacement (TAVR).

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“…Cardiac diseases are often associated with structural and functional insufficiency of adult aortic valvular cusps [1,2]. These are mostly characterized by aortic valve mineralization, followed by calcification and subsequent dysfunction with severe morbidity and mortality in humans [3,4]. According to World Health Organization, it is estimated that 17.9 million people (31%) died from different cardiovascular diseases in the year 2017.…”

Section: Introductionmentioning

confidence: 99%

Asporin Reduces Adult Aortic Valve Interstitial Cell Mineralization Induced by Osteogenic Media and Wnt Signaling Manipulation In Vitro

Polley

Khanam

Sengupta

et al. 2020

International Journal of Cell Biology

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Worldwide, calcific aortic valve disease is one of the leading causes of morbidity and mortality among patients with cardiac abnormalities. Aortic valve mineralization and calcification are the key events of adult calcific aortic valve disease manifestation and functional insufficiency. Due to heavy mineralization and calcification, adult aortic valvular cusps show disorganized and dispersed stratification concomitant with deposition of calcific nodules with severely compromised adult valve function. Interestingly, shared gene regulatory pathways are identified between bone-forming cells and heart valve cells during development. Asporin, a small leucine-rich proteoglycan (43 kDa), acts to inhibit mineralization in periodontal ligament cells and is also detected in normal murine adult aortic valve leaflets with unknown function. Therefore, to understand the Asporin function in aortic cusp mineralization and calcification, adult avian aortic valvular interstitial cell culture system is established and osteogenesis has been induced in these cells successfully. Upon induction of osteogenesis, reduced expression of Asporin mRNA and increased expression of bone and osteogenesis markers are detected compared to cells maintained without osteogenic induction. Importantly, treatment with human recombinant Asporin protein reduces the mineralization level in osteogenic media-induced aortic valvular interstitial cells with the concomitant decreased level of Wnt/β-catenin signaling. Overall, all these data are highly indicative that Asporin might be a novel biomolecular target to treat patients of calcific aortic valve disease over current cusp replacement surgery.

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Effect of age and aortic valve anatomy on calcification and haemodynamic severity of aortic stenosis

Cited by 52 publications

References 36 publications

Doppler Echocardiographic Quantitation of Aortic Valve Stenosis: A Science in Constant Evolution

Doppler Echocardiographic Quantitation of Aortic Valve Stenosis: A Science in Constant Evolution

Low Flow Low Gradient Severe Aortic Stenosis: Diagnosis and Treatment

Asporin Reduces Adult Aortic Valve Interstitial Cell Mineralization Induced by Osteogenic Media and Wnt Signaling Manipulation In Vitro

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