Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradients: risk stratification by low-dose dobutamine echocardiography

Monin, Jean‐Luc; Monchi, Mehran; Gest, V

doi:10.1016/s1062-1458(01)00506-2

Cited by 69 publications

(133 citation statements)

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“…[39][40][41] Doppler echocardiography at rest is not conclusive in such patients, requiring additional testing to differentiate truly severe from pseudosevere AS. 35,38,42,43 Catheterization is often not helpful because of similar discrepancies in AS severity markers, 44 whereas crossing the aortic valve also carries a significant risk of cerebral embolism, 45,46 and stress Doppler echocardiography is not always conclusive. 35 Hence, CT has emerged as an adjunct to Doppler echocardiography in the determination of AS severity.…”

Section: Avc-as Diagnosismentioning

confidence: 99%

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Aggarwal

Clavel

Messika–Zeitoun

et al. 2013

Circ: Cardiovascular Imaging

213

130

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A ortic stenosis (AS) is common in elderly people, affecting 2% of the population ≥65 years old and 4.6% of population ≥75 years old based on Doppler echocardiographic or community studies.1,2 Nowadays, the most common cause of AS is degenerative, and aortic valve calcification (AVC) is the intrinsic mechanism of valvular stiffening and obstruction. [3][4][5][6] Although degenerative AS has long been considered age related, recent studies have demonstrated that it is an active process involving biological pathways with many similarities to atherosclerosis. 7,8 Epidemiological studies identified similar risk factors for calcific AS and coronary atherosclerosis such as age, smoking, elevated cholesterol levels, diabetes mellitus, metabolic syndrome, hypertension, and increase in lipoprotein-a levels. 9 Male sex was also touted as an independent risk factor for AS similar to atherosclerosis, 9 but studies linking valve tissue alterations 10,11 and calcification to AS 12 have not differentiated between men and women. Moreover, studies of aortic valve weight as a surrogate for calcification load showed discordant results with regard to sex, 13,14 and clinically, guidelines do not differentiate between men and women for AS pathophysiology and management. 6 However, the analogy to atherosclerosis suggests that there may be important, yet thus far undefined, sex-related differences in the development of AVC and the transition to AS. This issue can now be analyzed because cardiac computed tomography (CT) provides accurate and reproducible quantification of AVC load, 15 and multidetector CT (MDCT) may prove to be a useful adjunct tool for the evaluation of AS severity. However, previous studies suggested a single set of cutoff values for detecting severe AS regardless of sex, 16 so the impact of sex on the relation between aortic cusp calcification measured by MDCT and hemodynamic severity of AS remains uncertain. The aim of the present study was to determine the differential physiological relationship between AVC Background-Aortic valve calcification (AVC) is the intrinsic mechanism of valvular obstruction leading to aortic stenosis (AS) and is measurable by multidetector computed tomography. The link between sex and AS is controversial and that with AVC is unknown. Methods and Results-We Conclusions-In Aggarwal et al Aortic Valve Calcification in Women 41load and AS hemodynamic severity between men and women. We hypothesized that women reach thresholds for severe AS for lower calcification loads than men and that when MDCT is used for the diagnosis of AS severity, criteria of AVC load would need to be adjusted specifically for each sex. Methods Study PopulationWe prospectively enrolled patients with at least mild calcific AS in whom we performed noncontrast MDCT scan for the evaluation of AVC and comprehensive transthoracic echocardiography within 90 Creatinine Clearance age k gPatients from the Bichat Hospital were enrolled in 2 ongoing prospective studies on aortic valve calcification/stenosis (COFRASA; www.clinica...

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Section: Avc-as Diagnosismentioning

confidence: 99%

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Aggarwal

Clavel

Messika–Zeitoun

et al. 2013

Circ: Cardiovascular Imaging

213

130

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“…(73) Patients who have true fixed, severe aortic stenosis and left ventricular contractile reserve, defined as an increase in stroke volume ≥20% during dobutamine echocardiography, have a much better postoperative outcome than those without contractile reserve (stroke volume increase <20%). (104)(105)(106) However, patients without left ventricular contractile reserve should still be considered for aortic valve replacement surgery, even though their surgical risk is higher, (107,108) since the outlook without surgery is dismal. A significant number of patients with aortic stenosis will have coronary artery disease (109) and assessment for coexistent coronary artery disease in these patients should be by coronary angiography.…”

Section: Aortic Stenosis With Normal Left Ventricular Systolic Functionmentioning

confidence: 99%

When to use stress echocardiography in the evaluation of patients with valvular heart disease

Nkomo

Pellikka

Enríquez-Sarano

et al. 2017

SAHJ

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“…Management decisions are more difficult when contractile reserve is absent. Contractile reserve is defined as an increase in stroke volume (SV) Ն20% using the criteria of Nishimura et al (24) and Monin et al (25). When contractile reserve is elicited, patients with true severe AS manifest an increase in transvalvular pressure gradient (⌬P) with a low calculated aortic valve area (AVA).…”

Section: Asmentioning

confidence: 99%

“…An AVA Proj Յ1.0 cm 2 is considered an indicator of true severe stenosis (30 (25), have a much better outcome with AVR than with medical therapy (26,27). Patients with a lack of LV functional reserve have been shown to have a poor prognosis with either medical or surgical management (25), but as a group they may also benefit from AVR (27,31). In other words, once true severe AS has been documented, AVR might be reasonable even in the absence of LV functional reserve, although decisions in these high-risk patients must be individualized in the absence of clear guidelines.…”

Section: Asmentioning

confidence: 99%

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

Lancellotti¹,

Monin²,

Bonow³

2009

Stress Echocardiography

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Exercise testing has an established role in the evaluation of patients with valvular heart disease and can aid clinical decision making. Because symptoms may develop slowly and indolently in chronic valve diseases and are often not recognized by patients and their physicians, the symptomatic, blood pressure, and electrocardiographic responses to exercise can help identify patients who would benefit from early valve repair or replacement. In addition, stress echocardiography has emerged as an important component of stress testing in patients with valvular heart disease, with relevant established and potential applications. Stress echocardiography has the advantages of its wide availability, low cost, and versatility for the assessment of disease severity. The versatile applications of stress echocardiography can be tailored to the individual patient with aortic or mitral valve disease, both before and after valve replacement or repair. Hence, exercise-induced changes in valve hemodynamics, ventricular function, and pulmonary artery pressure, together with exercise capacity and symptomatic responses to exercise, provide the clinician with diagnostic and prognostic information that can contribute to subsequent clinical decisions. Nevertheless, there is a lack of convincing evidence that the results of stress echocardiography lead to clinical decisions that result in better outcomes, and therefore large-scale prospective randomized studies focusing on patient outcomes are needed in the future. Advances in diagnosis and risk stratification, combined with steady progress in surgical valve replacement and repair, have led to improved outcomes of patients with valvular heart disease over the past 5 decades. The most important indication for surgical intervention in patients with hemodynamically significant aortic or mitral valve disease is the development of symptoms, as emphasized in recent guidelines (1,2). Because symptoms may develop slowly and indolently in these chronic conditions, many patients are unaware of subtle changes in effort tolerance, even when questioned directly by their physicians. Hence, guidelines of both the American College of Cardiology/American Heart Association (ACC/AHA) and the European Society of Cardiology (ESC) (1,2) have placed renewed emphasis on the role of exercise testing to provide objective evidence of exercise capacity and symptom status. In addition, although Doppler echocardiography at rest is the method of choice for assessing severity of valvular disease, there is a growing use of stress 2-dimensional and Doppler echocardiography to assess dynamic changes in hemodynamics in concert with the clinical findings of exercise testing.Stress echocardiography is well established for evaluating patients with coronary artery disease (CAD) (3-5). The role of stress echocardiography for the assessment of the hemodynamic consequences of valvular lesions was initially proposed in the 1980s (6,7) but only recently gained recognition by specialized and general guidelines (1,2,8,9). In a number...

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Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradients: risk stratification by low-dose dobutamine echocardiography

Cited by 69 publications

References 0 publications

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

Sex Differences in Aortic Valve Calcification Measured by Multidetector Computed Tomography in Aortic Stenosis

When to use stress echocardiography in the evaluation of patients with valvular heart disease

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

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