Clinical Usefulness of Pressure Recovery Adjustment in Patients with Predominantly Severe Aortic Stenosis: Asian Valve Registry Data

Heo, Ran; Jin, Xiaowei; Oh, Jin Kyung; Kim, Yong Jin; Park, Sung‐Ji; Park, Seung Woo; Ling, Lieng H.; Fukuda, Shota; Sohn, Dae Won; Song, Jae Kwan

doi:10.1016/j.echo.2019.10.007

Cited by 11 publications

(12 citation statements)

References 31 publications

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“…11 In another recent study of a large cohort of 697 patients, 24.8% of patients initially classified as having severe prosthetic stenosis (EOA 1.0 cm 2 ) were reclassified as having moderate stenosis (1.0 < EOA 1.5) after adjustment for PR using the ELCO equation. 12 In the latter study, the prevalence of significant reclassification was highest (33.8%) in patients with aortic dimensions 2.5 cm and significant (19.8%) in patients with aortic dimensions between 3.0 cm and 3.5 cm, with a drop-off as aortic dimensions increased >3.5 cm. 12 These results are quite significant and suggest that PR should be taken into account using the ELCO when grading AS, especially in the setting of small aortic dimensions.…”

Section: As and Correcting With Energy Loss Coefficientmentioning

confidence: 66%

“…12 In the latter study, the prevalence of significant reclassification was highest (33.8%) in patients with aortic dimensions 2.5 cm and significant (19.8%) in patients with aortic dimensions between 3.0 cm and 3.5 cm, with a drop-off as aortic dimensions increased >3.5 cm. 12 These results are quite significant and suggest that PR should be taken into account using the ELCO when grading AS, especially in the setting of small aortic dimensions.…”

Section: As and Correcting With Energy Loss Coefficientmentioning

confidence: 66%

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Elevated Prosthetic Valve Gradients: What to Consider When Determining an Etiology

Dietrich

Mankad

2021

Journal of Cardiothoracic and Vascular Anesthesia

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DOPPLER echocardiography is a useful noninvasive tool for the assessment of cardiac hemodynamics. However, it is subject to limitations that can have important clinical implications, especially in the setting of valve prosthesis. Elevation in mean transvalvular gradient is a finding that has a variety of etiologies. One such etiology is the pressure-recovery (PR) phenomenon, a consequence of stream convergence and energy conversion across a narrowing, which is an artifact of Doppler echocardiographic calculations of valvular flow. The elevated gradient measured with Doppler echocardiography as a result of PR is not present on cardiac catheterization and does not represent true problematic valve hemodynamics. PR should be suspected with an elevated gradient on Doppler echocardiography with normal leaflet motion, especially in the setting of a small proximal aorta. Understanding and awareness of PR are important because PR can lead to overestimation of disease severity in the clinical setting.

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Section: As and Correcting With Energy Loss Coefficientmentioning

confidence: 66%

Section: As and Correcting With Energy Loss Coefficientmentioning

confidence: 66%

Elevated Prosthetic Valve Gradients: What to Consider When Determining an Etiology

Dietrich

Mankad

2021

Journal of Cardiothoracic and Vascular Anesthesia

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“…Reclassification was considered to occur if a patient received a lower grade of AS severity using ELI compared to AVAi, e.g. severe by AVAi but moderate by ELI (>0.6 cm 2 /m 2 but <0.85 cm 2 /m 2 ), as per previous studies on pressure recovery adjustment of AS grade 11,12,14 .…”

Section: Discussionmentioning

confidence: 99%

“…10 Moving from smaller experimental studies to larger epidemiological studies, attempts have been made to prove that pressure recovery is a clinically relevant parameter in the risk assessment of patients with AS. [11][12][13][14] However, evidence of improved risk assessment by using ELI instead of unadjusted AVA is scarce, and results have either been driven by aortic valve replacement numbers 10,13 or flawed by not considering pre-existing differences between patients that were reclassified after pressure recovery adjustment to those that were not 12,14 Despite previous attempts, it is still not known whether pressure recovery adjustment improves risk stratification of AS patients. Therefore, we aimed to evaluate the prognostic value of both AVAi and ELI in a head-to-head comparison using large-scale, real-world data.…”

Section: Introductionmentioning

confidence: 99%

Energy-loss index does not improve risk prediction in aortic stenosis compared to conventional aortic valve area assessment

Lindow

Playford

Strange

et al. 2023

Preprint

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Background: Evidence of improved risk assessment in aortic stenosis (AS) by using energy-loss index (ELI) instead of aortic valve area indexed to body surface area (AVAi) is scarce, and positive results have been driven by aortic valve replacement. We aimed to evaluate the prognostic performance of ELI and AVAi in a head-to-head comparison using large-scale, real-world data. Methods: In the multi-center, mortality-data linked National Echocardiography Database of Australia (NEDA), patients with AS and requisite ascending aortic area measurements were identified. The prognostic value of AVAi and ELI, respectively, was analyzed using Cox regression and the C statistic. Results: In patients with mild AS (n=3,179), moderate AS (n=4,194), and severe AS (n=3,120), there were 4,229 deaths of which 2,359 were reported as cardiovascular deaths (median [interquartile range] follow-up 2.5 [1.1-4.5] years]. Decreasing AVAi was associated with increased cardiovascular mortality (hazard ratio [95% confidence interval] 1.18 [1.16-1.20] per 0.1 cm2/m2 downward increment]. Prognostic performance for 5-year mortality did not improve by using ELI instead of AVAi (identical C statistics 0.626 [0.612-0.640]), and the relative performance did not change when analyzing 1-year cardiovascular mortality, or all-cause mortality. Conclusion: ELI was not associated with improved prognostic performance compared to AVAi in echocardiographic assessment of AS using large-scale, real-world clinical data. AVAi remains a relevant measure for risk prediction in AS, providing information on incremental risk with decreasing area.

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“…The reclassified moderate AS patients had a significantly better 4-year clinical event-free survival compared with patients who remained in the severe AS subgroup. 33 However, there is a paucity of data in the TAVR population. The SE THV is relatively less performed in patients with a dilated AA (>43 mm) or severely angulated aorta (aortoventricular angle >70°).…”

Section: Discussionmentioning

confidence: 99%

Gradient and pressure recovery of a self-expandable transcatheter aortic valve depends on ascending aorta size: In vitro study

et al. 2022

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Clinical Usefulness of Pressure Recovery Adjustment in Patients with Predominantly Severe Aortic Stenosis: Asian Valve Registry Data

Cited by 11 publications

References 31 publications

Elevated Prosthetic Valve Gradients: What to Consider When Determining an Etiology

Elevated Prosthetic Valve Gradients: What to Consider When Determining an Etiology

Energy-loss index does not improve risk prediction in aortic stenosis compared to conventional aortic valve area assessment

Gradient and pressure recovery of a self-expandable transcatheter aortic valve depends on ascending aorta size: In vitro study

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