Mechanistic Insights and Clinical Significance of the Association Between Severe Isolated Aortic Stenosis, Severely Impaired Left Ventricular Systolic Function and High Transvalvular Gradients

Barasch, Eddy; Petillo, Florentina; Holtzman, Dvorah; Rhee, Peter; Posina, Kanna; Akhter, Muhammad Saeed; Sawhney, Sabrina; Pollack, Simcha; Reichek, Nathaniel

doi:10.1016/s0735-1097(12)62009-9

Cited by 4 publications

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“…В настоящее время эхокардиография (ЭхоКГ) является основным методом для диагностики степени тяжести аортального стеноза (АС). По данным литературы, в 30-40% случаев эта оценка может быть затруднена из-за диссоциации ЭхоКГпоказателей [1][2][3][4], поэтому зачастую остаётся неопределённость в отношении фактической выраженности АС и направления пациента на хирургическую коррекцию порока аортального клапана (АК). В нескольких недавних исследованиях показано, что в таких случаях отношение времени ускорения к общему времени выброса (AT/ET) может оказаться полезным параметром для определения степени АС [5][6][7][8][9][10].…”

Section: обоснованиеunclassified

A comparison of the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis in patients with bicuspid and tricuspid aortic valve: retrospective comparative study

et al. 2023

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Objective. We aimed to compare the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis (AS) in patients with bicuspid and tricuspid aortic valves (AV). Material and methods. We retrospectively analyzed the data of 187 patients with moderate and severe AS who underwent diagnostic examination at the Penza Federal Center for Cardiovascular Surgery. The patients were divided into 2 groups based on whether their AV was tricuspid or bicuspid. Visual assessment of the AV structure was performed using transthoracic echocardiography (TTE). In indeterminate cases, computed tomography was used for the assessment. Results. A comparative analysis of the echocardiographic characteristics of patients with tricuspid and bicuspid AV did not reveal a statistically significant difference between the patient groups (p 0.05). Linear regression analysis in patients with a tricuspid AV demonstrated a statistically significant correlation between AT/ET scores and peak gradient (Gmax) (r=0.68, р=0.03), mean gradient (Gmean) (r=0.78, р=0.01), effective orifice area (EOA) (r=0.7, р=0.03), and doppler velocity index (DVI) scores (r=0.72, р=0.02). In patients with a bicuspid AV, a similarly significant correlation was found between the AT/ET index and Gmax (r=0.67, р=0.02), Gmean (r=0.8, р 0.001), EOA (r=0.72, р=0.04), and DVI (r=0.75, р=0.01). The receiver operating characteristic analysis demonstrated a high predictive ability of AT/ET for severe aortic valve stenosis (with a value 0.35). The area under the curve in patients with tricuspid and bicuspid AV was 84 (p 0.001) and 86 (p 0.001), respectively. For determining severe AV stenosis in patients with a tricuspid AV, the sensitivity and specificity of AT/ET 0.35 was 84% and 75%, respectively; and in patients with a bicuspid AV, it was 87% and 78%, respectively. Conclusion. The AT/ET ratio has comparable diagnostic capabilities in determining severe AS in patients with tricuspid and bicuspid AV structures. The AT/ET 0.35 is a highly sensitive parameter for defining severe AS for both morphologies of AV.

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Section: обоснованиеunclassified

A comparison of the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis in patients with bicuspid and tricuspid aortic valve: retrospective comparative study

et al. 2023

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“…In the last years, a second type of LF-LG AS patients has been recognised with low-flow conditions caused by a decreased stroke volume due to a small LV cavity size and restrictive physiology [ 5 ]. This phenomenon has been described as “paradoxical” low-flow, low-gradient AS (PLF-LGAS), as it might be observed despite a preserved EF (LVEF ≥ 50%) in approximately 10–25% of patients with severe AS [ 7 , 11 , 12 , 13 , 14 ]. In patients with LFLG-AS, surgical aortic valve replacement (SAVR) has been associated with a significant improvement in mid- to long-term survival, but operative mortality remains high (6% to 30%) [ 9 , 15 , 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation

Oikonomou,

Apostolos,

Drakopoulou

et al. 2024

JCM

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Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow—low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m2 and mean gradient (MG) < 40 mmHg); (ii) normal flow—low gradient (NF-LG): SVi > 35 mL/m2 and MG < 40 mmHg; (iii) low flow—high gradient (LF-HG): Svi 35 mL/m2 and MG ≥ 40 mmHg and (iv) normal flow—high gradient (NF-HG): SVi > 35 mL/m2 and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918–0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645–5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106–1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p < 0.001) and a lower Svi (p < 0.001) at baseline were associated with LVEF improvement at 1-year. Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year.

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“…However, there is controversy over the appropriate severity classification and management of patients with NFLG-AS [3,4,6]. As a result, indications for surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) in patients with symptomatic NFLG-AS are inconsistent [5,7]. Prior studies demonstrate that SAVR in patients with severe NFLG-AS have improved survival when compared with medical management [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Short-Term Outcomes Following Transcatheter Aortic Valve Implantation: Classical Low-Flow Low-Gradient Versus Normal-Flow Low-Gradient Severe Aortic Stenosis

Fogelson,

Baljepally,

Tahir

et al. 2023

J Clin Cardiol

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Background: Both classical severe low-flow low-gradient aortic stenosis (LFLG-AS) and severe normal-flow low-gradient aortic stenosis (NFLG-AS) patients undergo transcatheter aortic valve implantation (TAVI). However, few studies have compared outcomes between the two groups. Our study aimed to assess short term post-TAVI outcomes between classical LFLG-AS and NFLG-AS. Methods: We conducted a retrospective, single-center, analysis of 206 patients who underwent TAVI between January 2011 to September 2020. Of these, 44 (males: 33) had classical LFLG-AS and 162 (males: 89) had NFLG-AS. Six-month primary outcomes included all-cause and cardiovascular mortality. Multiple secondary outcomes were assessed including stroke, myocardial infarction (MI), new-onset atrial fibrillation, acute kidney injury (AKI), major bleeding, vascular complications, and repeat hospitalizations from cardiac causes. Results: The cumulative six-month all-cause and cardiovascular mortality were similar between classical severe LFLG-AS and NFLG-AS patients (6.81 % vs. 4.32 %, P = 0.49 and 2.27 % vs. 2.47 %, P = 0.93 respectively). All secondary outcomes were also similar, except for a statistically significant higher rate of AKI in patients with classical LFLG-AS (P = < 0.0001). Conclusion: Except for a higher incidence of AKI in patients with severe classical LFLG-AS, six-month post-TAVI outcomes did not differ between classical LFLG-AS and NFLG-AS.

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Mechanistic Insights and Clinical Significance of the Association Between Severe Isolated Aortic Stenosis, Severely Impaired Left Ventricular Systolic Function and High Transvalvular Gradients

Cited by 4 publications

References 0 publications

A comparison of the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis in patients with bicuspid and tricuspid aortic valve: retrospective comparative study

A comparison of the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis in patients with bicuspid and tricuspid aortic valve: retrospective comparative study

Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation

Short-Term Outcomes Following Transcatheter Aortic Valve Implantation: Classical Low-Flow Low-Gradient Versus Normal-Flow Low-Gradient Severe Aortic Stenosis

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