Impact of stroke volume assessment by integrating multi-detector computed tomography and Doppler data on the classification of aortic stenosis

Stähli, Barbara E.; Stadler, Thomas M; Holy, Erik W.; Nguyen-Kim, Thi Dan Linh; Hoffelner, L; Erhart, Ladina; Obeid, Slayman; Niemann, Markus; Jenni, Rolf; Hamada, Sandra; Manka, Robert; Lüscher, Thomas F.; Nietlispach, Fabiàn; Frauenfelder, Thomas; Tanner, Felix C.

doi:10.1016/j.ijcard.2017.03.112

Cited by 13 publications

(7 citation statements)

References 36 publications

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“… 2 , 5 In the first study concerning PLF severe AS, the SVs derived from the LVOT and the Simpson's method were comparable, 6 which was also found in a more recent study comprising patients with mild-to-severe AS. 7 Conversely, a significantly lower SV by the biplane Simpson's method was observed by Stähli and collegues, 8 by Iwataki and collegues, 9 and by the World Alliance of Societies of Echocardiography 10 in 1450 healthy adult volunteers. In the current study, SV volumetric was expected to approximate the forward SV LVOT since patients with more than mild mitral or tricuspid regurgitation were excluded.…”

Section: Discussionmentioning

confidence: 86%

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The robustness of the flow-gradient classification of severe aortic stenosis

Velders,

Vriesendorp,

Asch

et al. 2023

JTCVS Open

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Section: Discussionmentioning

confidence: 86%

“… 2 , 5 Although fair agreement between these SV methods was reported by some studies, 6 , 7 several other studies found poor agreement. 8 , 9 , 10 The consequences for the flow-gradient classification, which are directly relevant to clinical practice, are still unclear.…”

mentioning

confidence: 99%

The robustness of the flow-gradient classification of severe aortic stenosis

Velders,

Vriesendorp,

Asch

et al. 2023

JTCVS Open

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“…Measurement of the degree of aortic valve calcification (AVC) using multi-detector computed tomography (MDCT) is an accurate, flow-independent method to assess AS severity including LG-AS 17 . Stroke volume assessment by MDCT and Doppler data may be considered to avoid misclassifications in patients with LG-SAS due to the elliptical shape of the LVOT 18 . Recent data have suggested that calculation of projected AVA derived from preload or dobutamine/exercise stress echocardiography may be useful to predict adverse events in patients with LG-AS and preserved EF 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of the Ratio of Acceleration Time to Ejection Time in Patients With Low Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

Altes

Thellier

Bohbot

et al. 2019

The American Journal of Cardiology

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“…In ECG-gated studies that include end-systolic and end-diastolic phases, an accurate estimation of LV function can be made by allowing accurate estimation of stroke volume and flow. Both CT and MRI angiographic studies have shown that this results in improved classification of AS based on flow and function 30…”

Section: Discussionmentioning

confidence: 99%

Inconsistency in aortic stenosis severity between CT and echocardiography: prevalence and insights into mechanistic differences using computational fluid dynamics

Mittal¹,

Reichmuth

Bhattacharyya

et al. 2019

Open Heart

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ObjectivesThe aims of this study were to evaluate the inconsistency of aortic stenosis (AS) severity between CT aortic valve area (CT-AVA) and echocardiographic Doppler parameters, and to investigate potential underlying mechanisms using computational fluid dynamics (CFD).MethodsA total of 450 consecutive eligible patients undergoing transcatheter AV implantation assessment underwent CT cardiac angiography (CTCA) following echocardiography. CT-AVA derived by direct planimetry and echocardiographic parameters were used to assess severity. CFD simulation was performed in 46 CTCA cases to evaluate velocity profiles.ResultsA CT-AVA>1 cm2 was present in 23% of patients with echocardiographic peak velocity≥4 m/s (r=−0.33) and in 15% patients with mean Doppler gradient≥40 mm Hg (r=−0.39). Patients with inconsistent severity grading between CT and echocardiography had higher stroke volume index (43 vs 38 mL/m2, p<0.003) and left ventricular outflow tract (LVOT) flow rate (235 vs 192 cm3/s, p<0.001). CFD simulation revealed high flow, either in isolation (p=0.01), or when associated with a skewed velocity profile (p=0.007), as the main cause for inconsistency between CT and echocardiography.ConclusionSevere AS by Doppler criteria may be associated with a CT-AVA>1 cm2 in up to a quarter of patients. CFD demonstrates that haemodynamic severity may be exaggerated on Doppler analysis due to high LVOT flow rates, with or without skewed velocity profiles, across the valve orifice. These factors should be considered before making a firm diagnosis of severe AS and evaluation with CT can be helpful.

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Impact of stroke volume assessment by integrating multi-detector computed tomography and Doppler data on the classification of aortic stenosis

Cited by 13 publications

References 36 publications

The robustness of the flow-gradient classification of severe aortic stenosis

The robustness of the flow-gradient classification of severe aortic stenosis

Prognostic Impact of the Ratio of Acceleration Time to Ejection Time in Patients With Low Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

Inconsistency in aortic stenosis severity between CT and echocardiography: prevalence and insights into mechanistic differences using computational fluid dynamics

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