Impact of Pressure Recovery on Echocardiographic Assessment of Asymptomatic Aortic Stenosis: A SEAS Substudy

Bahlmann, Edda; Cramariuc, Dana; Gerdts, Eva; Gohlke-Baerwolf, Christa; Nienaber, Christoph; Eriksen, Erlend; Wachtell, Kristian; Chambers, John; Kuck, Karl Heinz; Ray, Simon

doi:10.1016/j.jcmg.2009.11.019

Cited by 111 publications

(142 citation statements)

References 30 publications

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“…15-17 These discrepancies may become larger in patients with a smaller diameter of the ascending aorta, and routine calculation of ELCo is recommended for assessing aortic stenosis in patients with aortic diameter <3 cm. 26 The difference in ELCoI was larger than the difference in EOAI, and this suggests the benefit of the Trifecta valve in patients with a small valve size.…”

Section: Regression Analysismentioning

confidence: 98%

Early Hemodynamic Performance of the Trifecta Bioprosthetic Valve in Patients With Aortic Valve Disease

Maruyama

Daimon

Kawata

et al. 2014

Circ J

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Section: Regression Analysismentioning

confidence: 98%

Early Hemodynamic Performance of the Trifecta Bioprosthetic Valve in Patients With Aortic Valve Disease

Maruyama

Daimon

Kawata

et al. 2014

Circ J

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“…6 In particular, AS severity is frequently overestimated by AVAI in patients with milder degree of AS if pressure recovery in the aortic root is not taken into account. 7 Recently, it was demonstrated that patients with inconsistently graded severe AS had a prognosis comparable to that seen in patients with moderate AS. 8 Whether assessment of pressure recovery adjusted AVAI (energy loss index [ELI]) in this setting could add accuracy to risk assessment is unknown.…”

mentioning

confidence: 99%

Prognostic Value of Energy Loss Index in Asymptomatic Aortic Stenosis

et al. 2013

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Background— Aortic valve area index adjusted for pressure recovery (energy loss index [ELI]) has been suggested as a more accurate measure of aortic stenosis (AS) severity, but its prognostic value has not been determined in a prospective study. Methods and Results— The relation between baseline ELI and rate of aortic valve events and combined total mortality and hospitalization for heart failure resulting from the progression of AS was assessed by multivariate Cox regression and reclassification analysis in 1563 patients with initial asymptomatic AS in the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. During 4.3 years follow-up, a total of 498 aortic valve events and 181 combined total mortalities and hospitalizations for heart failure caused by the progression of AS occurred. In Cox regression analyses, 1-cm 2 /m 2 lower baseline ELI predicted a 2-fold higher risk both for aortic valve events and for combined total mortality and hospitalization for heart failure independently of baseline peak aortic jet velocity or mean aortic gradient and independently of aortic root size (all P <0.05). In reclassification analysis, ELI improved the prediction of aortic valve events by 13% (95% confidence interval, 5–19), whereas the prediction of combined total mortality and hospitalization for heart failure resulting from the progression of AS did not improve significantly. Conclusions— In asymptomatic AS patients without known atherosclerotic disease or diabetes mellitus, ELI provides independent and additional prognostic information to that derived from conventional measures of AS severity, suggesting that ELI should be measured in such patients. Clinical Trial Registration Information— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00092677.

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“…This difficulty may increase the possibility of over-or under-estimation of the AVA. In addition, although transvalvular pressure gradients are useful for the diagnosis of aortic stenosis, they might be overestimated when a pressure recovery phenomenon has occurred; 3,4) therefore, TTE including Doppler study is essential for the diagnosis of aortic stenosis, but it also has limitations. On the other hand, ECG-gated MDCT gives high resolution images and large amounts of information.…”

Section: Discussionmentioning

confidence: 99%

“…1) The surgical indication for SVD is wide according to functional valvular deterioration by Doppler study of transthoracic echocardiography (TTE). 3,4) The surgical procedure is almost always replacement. Thus, surgeons do not pay attention to the degree of valvular deformity.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Structural Deterioration in an Aortic Bioprosthetic Valve by Multidetector Row Computed Tomography: Report of a Case

Teshima

Akasu

Arinaga

et al. 2014

ATCS

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A 32-year-old female patient presented with shortness of breath. The patient had received aortic valve replacement with a 25-mm bioprosthetic valve at the age of 22, and had had two babies, postoperatively. Ten years later, echocardiography showed the calcified bioprosthetic valve with a high peak pressure gradient (70 mmHg) and a reduced valve orifice area (0.46 cm 2 ). Electrocardiographically gated multidetector row computed tomography (ECG-gated MDCT) clearly demonstrated calcified bioprosthetic cusps with reduced mobility, and the valve orifice area was measured to be 0.64 cm 2 by direct planimetry. These findings observed by ECG-gated MDCT were confirmed at reoperation. This is the first reported reoperation case of aortic structural valve deterioration clearly visualized by ECG-gated MDCT.

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Impact of Pressure Recovery on Echocardiographic Assessment of Asymptomatic Aortic Stenosis: A SEAS Substudy

Abstract: For accurate assessment of AS severity, pressure recovery adjustment of AVA must be routinely performed. Estimation of pressure recovery at the sinotubular junction is suggested.

Cited by 111 publications

References 30 publications

Early Hemodynamic Performance of the Trifecta Bioprosthetic Valve in Patients With Aortic Valve Disease

Early Hemodynamic Performance of the Trifecta Bioprosthetic Valve in Patients With Aortic Valve Disease

Prognostic Value of Energy Loss Index in Asymptomatic Aortic Stenosis

Diagnosis of Structural Deterioration in an Aortic Bioprosthetic Valve by Multidetector Row Computed Tomography: Report of a Case

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