Progression of Low-Gradient, Low-Flow, Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction

Tribouilloy, Christophe; Ruşinaru, Dan; Charles, Vincent; Boulif, Jamila; Maes, Frédéric; Lévy, F.; Pasquet, Agnès; Maréchaux, Sylvestre; Vanoverschelde, Jean-Louis

doi:10.1016/j.amjcard.2015.05.023

Cited by 24 publications

(11 citation statements)

References 24 publications

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“…The observed increase in gradients during serial echocardiographic examinations in these studies is compatible with the hypothesis that in many patients low flow low gradient AS with normal LV function may represent an intermediate stage of AS, between moderate and high gradient AS, rather than a more advanced stage of the disease [19], a conclusion further supported by the study by Slimani et al [22], which demonstrated that patients with paradoxical low flow low gradient severe AS less frequently display reduced longitudinal deformation, LV hypertrophy, or myocardial fibrosis than patients with high gradient severe AS [22].…”

Section: Comparison With Previous Studiessupporting

confidence: 86%

Pseudo-discordance mimicking low-flow low-gradient aortic stenosis in transcatheter aortic valve replacement patients with severe symptomatic aortic stenosis

et al. 2023

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Background: While the combination of a small aortic valve area (AVA) and low mean gradient is frequently labeled 'low-flow low-gradient aortic stenosis (AS)', there are two potential causes for this finding: underestimation of mean gradient and underestimation of AVA. Methods:In order to investigate the prevalence and causes of discordant echocardiographic findings in symptomatic patients with AS and normal left ventricular (LV) function, we evaluated 72 symptomatic patients with AS and normal LV function by comparing Doppler, invasive, computed tomography (CT) LV outflow tract (LVOT) area, and calcium score (CaSc).Results: Thirty-six patients had discordant echocardiographic findings (mean gradient < 40 mmHg, AV area ≤ 1 cm 2 ). Of those, 19 had discordant invasive measurements (true discordant [TD]) and 17 concordant (false discordant [FD]): In 12 of the FD the mean gradient was > 30 mmHg; technical pitfalls were found in 10 patients (no reliable right parasternal Doppler in 6). 1LVOT area by echocardiography or CT could not differentiate between concordants and discordants nor between TD and FD (p = NS). CaSc was similar in concordants and FD (p = 0.3), and it was higher in true concordants than in TD (p = 0.005). CaSc positive predictive value for the correct diagnosis of severe AS was 95% for concordants and 93% for discordants.Conclusions: Discordant echocardiographic findings are commonly found in patients with symptomatic AS. Underestimation of the true mean gradient due to technical difficulties is an important cause of these discrepant findings. LVOT area by echocardiography or CT cannot differentiate between TD and FD. In the absence of a reliable and compete multi-window Doppler evaluation, patients should undergo CaSc assessment.

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Section: Comparison With Previous Studiessupporting

confidence: 86%

Pseudo-discordance mimicking low-flow low-gradient aortic stenosis in transcatheter aortic valve replacement patients with severe symptomatic aortic stenosis

et al. 2023

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“…65 The treatment of these patients is still controversial because some studies suggest that even asymptomatic patients with low-flow, low-gradient severe AS and a normal LVEF have a poor prognosis 24,45,[89][90][91][92] and might benefit from AVR (class IIa) while others suggest that many of these patients have only moderate stenosis and their outcomes are similar to moderate AS with normal flow across the aortic valve. 93,94 Both casecontrol and prospective studies suggest that outcomes are worse in symptomatic patients with low-flow, low-gradient AS and a normal LVEF compared with patients with highgradient severe AS. Although no randomized clinical trials have been performed, a post hoc subset analysis of a randomized clinical trial suggests that survival may be improved with TAVR or AVR vs medical management in symptomatic patients with low-flow severe AS.…”

Section: Indications and Timing Of Replacement Asymptomaticmentioning

confidence: 99%

Management of Patients With Aortic Valve Stenosis

Kanwar

Thaden

Nkomo

2018

Mayo Clinic Proceedings

117

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With increased life expectancy and aging of the population, aortic stenosis is now one of the most common valvular heart diseases. Early recognition and management of aortic stenosis are of paramount importance because untreated symptomatic severe disease is universally fatal. The advent of transcather aortic valve replacement technologies provides exciting avenues of care to patients with this disease in whom traditional surgical procedures could not be performed or were associated with high risk. This review for clinicians offers an overview of aortic stenosis and updated information on the current status of various treatment strategies. An electronic literature search of PubMed, MEDLINE, EMBASE, and Scopus was performed from conception July 1, 2016, through November 30, 2017, using the terms aortic stenosis, aortic valve replacement, transcatheter aortic valve replacement (TAVR), transcatheter aortic valve insertion (TAVI), surgical aortic valve replacement, aortic stenosis flow-gradient patterns, low-flow aortic valve stenosis, natural history, stress testing, pathophysiology, bicuspid aortic valve, and congenital aortic valve disease.

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“…Tribouilloy et al. observed that the majority of patients with PLF/LG developed high‐gradient severe AS over time, and this condition is possibly an intermediate form of conventional severe AS . In contrast, Dahl et al.…”

Section: Evolving New Concepts In Assessment Of Aortic Stenosismentioning

confidence: 99%

Evolving new concepts in the assessment of aortic stenosis

Deeprasertkul

Ahmad

2017

Echocardiography

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Echocardiography has been pivotal in evaluating aortic stenosis (AS) over the past several decades. Recent experience has shown a wide spectrum in the clinical presentation of AS. A better understanding of the underlying hemodynamic principles has resulted in emergence of new subtypes of AS. New treatment modalities have also been introduced, requiring precise evaluation of aortic valve (AV) pathology for implementation of these therapies. This review will discuss new concepts and indices in the use of echocardiography in patients with AS. Specifically, we will address the hemodynamic characteristics, clinical presentation, and management of normal-flow, high-gradient; paradoxical low-flow, low-gradient; and classical low-flow, low-gradient aortic stenoses.

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Progression of Low-Gradient, Low-Flow, Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction

Cited by 24 publications

References 24 publications

Pseudo-discordance mimicking low-flow low-gradient aortic stenosis in transcatheter aortic valve replacement patients with severe symptomatic aortic stenosis

Pseudo-discordance mimicking low-flow low-gradient aortic stenosis in transcatheter aortic valve replacement patients with severe symptomatic aortic stenosis

Management of Patients With Aortic Valve Stenosis

Evolving new concepts in the assessment of aortic stenosis

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