Outcomes of Patients With Discordant High-Gradient Aortic Valve Stenosis

Vulesevic, Branka; Burwash, Ian G.; Beauchesne, Luc; Cimadevilla, Claire; Siouti, Leila; Tubiana, Sarah; Duval, Xavier; Nguyen, Virginia; Arangalage, Dimitri; Chan, Kwan L.; Mulvihill, Erin E.; Messika–Zeitoun, David

doi:10.1016/j.jcmg.2020.02.018

Cited by 9 publications

(3 citation statements)

References 3 publications

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“…Following the exclusion of conditions associated with high flow, patients identified as having true DHG-AS exhibit a less favorable prognosis when compared to individuals with concordant moderate AS, with survival rates that closely resemble those observed in cases of true severe AS [ 26 ]. Recent studies [ 27 , 28 ] have indicated that DHG-AS is not uncommon, with a prevalence of 10% among patients with mean PG exceeding 40 mmHg. These patients typically present with larger body surface areas, LVOT diameters, LVEF, SVi, and higher rates of aortic regurgitation, suggesting that these anatomical factors result in increased opening of the aortic valve leading to the discordant value.…”

Section: Diagnosismentioning

confidence: 99%

Unraveling the Enigma of Moderate Aortic Stenosis: Challenges and Future Prospects

Santangelo,

Tumminello,

Barbieri

et al. 2024

JCM

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According to current guidelines, only clinical surveillance is recommended for patients with moderate aortic valve stenosis (AS), while aortic valve replacement may be considered in patients undergoing surgery for other indications. Recent studies have shown that moderate AS is associated with a high risk of adverse cardiovascular events, including death, especially in patients with left ventricular dysfunction. In this context, multimodality imaging can help to improve the accuracy of moderate AS diagnosis and to assess left ventricular remodeling response. This review discusses the natural history of this valve disease and the role of multimodality imaging in the diagnostic process, summarizes current evidence on the medical and non-medical management, and highlights ongoing trials on valve replacement.

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Section: Diagnosismentioning

confidence: 99%

Unraveling the Enigma of Moderate Aortic Stenosis: Challenges and Future Prospects

Santangelo,

Tumminello,

Barbieri

et al. 2024

JCM

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“…17 Low-flow state was defined by an SV indexed (SVi) to body surface area < 35 mL/min/m 2 . We defined the group with Vmax > 4 m/s and DI > .25 with AVA > 1 cm 2 as "discordant moderate AS," while acknowledging that some groups consider these to be "discordant high gradient AS" 18 It should be noted that this category is of interest among those with ESKD with presence of AVF owing to the possibility of a high flow state.…”

Section: Echocardiographymentioning

confidence: 99%

“…The different echocardiographic parameters (Vmax, mean gradient, AVA, and dimensionless index) were consistent in each category of AS severity (Table 2). 13,17,18…”

Section: As Severity and Classificationmentioning

confidence: 99%

Impact of arteriovenous fistula on flow states in the evaluation of aortic stenosis among ESKD patients on dialysis

Ogugua,

Mathew,

Ternacle

et al. 2023

Echocardiography

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IntroductionAn arteriovenous fistula (AVF) in patients with end‐stage kidney disease (ESKD) can influence flow states. We sought to evaluate if assessment of aortic stenosis (AS) by transthoracic echocardiographic (TTE) differs in the presence of AVF compared to other dialysis accesses in patients on dialysis.MethodsWe identified consecutive ESKD patients on dialysis and concomitant AS from a single center between January 2000 and March 2021. We analyzed TTE parameters of AS severity (velocities, gradients, aortic valve area [AVA]) and hemodynamics (cardiac output [CO], valvuloarterial impedance [Zva]) and compared AS parameters in patients with AVF versus other dialysis access.ResultsThe cohort included 94 patients with co‐prevalent ESKD and AS; mean age 66 years, 71% male; 43% Black, 24% severe AS. Dialysis access: 53% AVF, 47% others. In the overall cohort, no significant differences were noted between AVF versus non‐AVF in AVA/CO/Zva, but with notable subgroup differences. In mild AS, CO was significantly higher in AVF versus non‐AVF (6.3 vs. 5.2 L/min; p = .04). In severe AS, Zva was higher in the AVF versus non‐AVF (4.6 vs. 3.6 mm Hg/mL/m2). With increasing AS severity in the AVF group, CO decreased, coupled with increase in Zva, likely counterbalancing the net hemodynamic impact of the AVF.ConclusionAmong ESKD patients with AS, TTE parameters of flow states and AS severity differed in those with AVF versus other dialysis accesses and varied with progression in severity of AS. Future longitudinal assessment of hemodynamic parameters in a larger cohort of co‐prevalent ESRD and AS would be valuable.

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Clinical, echocardiographic and prognostic outcomes of patients with concordant and discordant high-gradient aortic stenosis in an Asian cohort

Chew

Ngiam

et al. 2022

Int J Cardiovasc Imaging

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Outcomes of Patients With Discordant High-Gradient Aortic Valve Stenosis

Cited by 9 publications

References 3 publications

Unraveling the Enigma of Moderate Aortic Stenosis: Challenges and Future Prospects

Unraveling the Enigma of Moderate Aortic Stenosis: Challenges and Future Prospects

Impact of arteriovenous fistula on flow states in the evaluation of aortic stenosis among ESKD patients on dialysis

Clinical, echocardiographic and prognostic outcomes of patients with concordant and discordant high-gradient aortic stenosis in an Asian cohort

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