New concepts in valvular hemodynamics: Implications for diagnosis and treatment of aortic stenosis

Dumesnil, Jean G.

doi:10.1016/s0828-282x(07)71009-7

Cited by 43 publications

(29 citation statements)

References 66 publications

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“…In patients with hypertension and AS, the transvalvular flow rate may be significantly decreased despite normal LV ejection fraction. High blood pressure can markedly decrease (up to 40%) the peak‐to‐peak gradient, which is one of the main measures of AS severity used during cardiac catheterization . In this population the LV faces a double afterload: a valvular load, due to the AS, and an arterial load, as a consequence of reduced arterial compliance …”

Section: Preprocedural Assessmentmentioning

confidence: 99%

“…High blood pressure can markedly decrease (up to 40%) the peak-to-peak gradient, which is one of the main measures of AS severity used during cardiac catheterization. 12 In this population the LV faces a double afterload: a valvular load, due to the AS, and an arterial load, as a consequence of reduced arterial compliance. 13 The LV of patients with moderate AS and concomitant hypertension may face a global hemodynamic load equivalent, or even higher, than patients with severe AS but no hypertension.…”

Section: Severity Of Aortic Stenosismentioning

confidence: 99%

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Role of Multimodality Imaging in Transcatheter Aortic Valve Replacement

et al. 2014

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The treatment of aortic stenosis (AS) has reached an exciting stage with the introduction of transcatheter aortic valve replacement (TAVR). It is the treatment of choice in patients with severe AS who are considered very high risk for surgical valve replacement. Multimodality imaging (MMI) plays a crucial role in TAVR patient selection, intra-procedure guidance, and follow-up. With the ever-increasing scope for TAVR, a better understanding of MMI is essential to improve outcomes and prevent complications.

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Section: Preprocedural Assessmentmentioning

confidence: 99%

Section: Severity Of Aortic Stenosismentioning

confidence: 99%

Role of Multimodality Imaging in Transcatheter Aortic Valve Replacement

et al. 2014

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“…Severe aortic valve stenosis (AS) produces significant changes in the interdependent left and right ventricular haemodynamics 3 . Indeed, sustained pressure overload induces the development of myocardial hypertrophy which progressively impairs the diastolic properties of the left ventricle; its heightened filling pressures are then passively transmitted backwards, eliciting a reactive component within the pulmonary vasculature 4 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of invasive haemodynamic measurements in combination with clinical and echocardiographic characteristics on two-year clinical outcomes of patients undergoing transcatheter aortic valve implantation

Franzone¹,

O’Sullivan²,

Stortecky³

et al. 2017

EuroIntervention

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Aims: The aim of the study was to evaluate the prognostic utility of right heart catheterisation (RHC)-derived measures among patients undergoing transcatheter aortic valve implantation (TAVI). and December 2012 and undergoing preoperative RHC were analysed. The relationship between haemodynamic parameters and survival was evaluated with Cox proportional hazards models. At two-year follow-up, 118 patients had died (25.1%). At multivariable analysis, diabetes (hazard ratio [HR] 1.95, 95% confidence interval [CI]: 1.28-2.96, p=0.001), transapical access (HR 1.66, 95% CI: 1.07-2.56, p=0.02), and moderate or severe mitral regurgitation (HR 1.55, 95% CI: 1.00-2.39, p=0.04) were independent predictors of two-year mortality, whereas no correlation between RHC-derived measures and mortality was found. Furthermore, the addition of haemodynamic variables did not significantly improve the prognostic power of a model incorporating clinical and echocardiographic data p=0.47). Methods and results:Conclusions: On the basis of a comprehensive clinical and echocardiographic evaluation, RHC performed prior to TAVI does not add incremental prognostic value. KEYWORDS• aortic stenosis • risk stratification • transcatheter aortic valve implantation (TAVI)

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“…In severe aortic stenosis, these gradients can be decreased, as a consequence of a low ejection fraction, or in patients with preserved ejection fraction, but a low stroke volume (paradoxical aortic stenosis), because the gradients depend on transvalvular flow [2]. For this reason, the severity of aortic stenosis is classified according to effective valve area (AVAe), calculated from the continuity equation, taking in account that there may be errors due to the incorrect measurement of the left ventricular outflow tract and its elliptical shape, or to factors affected by aortic root size, such as pressure recovery [3] [4]. Using this method, the area obtaining the AVAe, is the area of the vena contracta, which is located above the anatomic valve area (AVAa) close to the level of the sinotubular junction; this corresponds to the site of maximal jet velocity (registered by continuous-wave Doppler) that results from the momentum of the blood passing through the stenotic valve.…”

Section: Introductionmentioning

confidence: 99%

Estimation of Contraction Coefficient of Gorlin Equation for Assessment of Aortic Valve Area in Aortic Stenosis

Migliore¹,

Adaniya²,

Barranco³

et al. 2017

WJCD

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Background: The Gorlin equation is the reference method for the assessment of aortic valve area in aortic stenosis and is calculated using a constant, called the coefficient of contraction, which is empirically assumed to be 1. This coefficient is the ratio of effective aortic area to anatomic aortic area, and a value of 1 indicates that both are the same. The purpose of this study was to estimate the actual coefficient of contraction in patients with aortic stenosis and to evaluate its impact on aortic area as calculated by the Gorlin equation. Methods: We studied 17 patients with moderate to severe aortic stenosis. Effective aortic area was calculated using the continuity equation. Anatomic aortic area was obtained by planimetry with transesophageal echocardiography. Aortic valve area by the Gorlin equation was calculated from echocardiography data. The coefficient of contraction was derived as above. Results: The coefficient of contraction was inversely related to the pressure recovery. Effective area was correlated with anatomic area (r = 0.86, P < 0.01) but there was a high mean difference (0.22 ± 0.14 cm 2 ). Aortic area by the Gorlin equation was not correlated with anatomic area, but the correlation became significant when the Gorlin equation was corrected for coefficient of contraction and pressure recovery. Conclusions: Using a coefficient of contraction of 1 in the Gorlin equation gives a poor correlation with anatomic area. Using the calculated coefficient of contraction for each patient and the mean gradient for pressure recovery improves the correlation with anatomic area. These facts could be taken in account when Gorlin equation is considered as the reference method.

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New concepts in valvular hemodynamics: Implications for diagnosis and treatment of aortic stenosis

Cited by 43 publications

References 66 publications

Role of Multimodality Imaging in Transcatheter Aortic Valve Replacement

Role of Multimodality Imaging in Transcatheter Aortic Valve Replacement

Prognostic impact of invasive haemodynamic measurements in combination with clinical and echocardiographic characteristics on two-year clinical outcomes of patients undergoing transcatheter aortic valve implantation

Estimation of Contraction Coefficient of Gorlin Equation for Assessment of Aortic Valve Area in Aortic Stenosis

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