Paradoxical Low Flow-Low Gradient Severe Aortic Stenosis: A Clinical Entity or a Scientific Artifact

Valencia-Serrano, Félix; Bustos, Daniel; Cabeza, Alejandro Pérez

doi:10.1016/s0735-1097(15)61981-7

Cited by 2 publications

(4 citation statements)

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“…The conditions listed are some of the most common causes for which some authors believe that this form of aortic stenosis with preserved ejection fraction and low flow called a paradoxical lowflow low-gradient aortic stenosis may in fact be a technical artifact. [26] The explanation of the increased frequency of this form in our study, compared to the data published in the literature, could be represented by the evaluation of all hospitalized patients with aortic stenosis and those referred by other medical services, known or not with this condition. Studies in the literature do not always specify the methodology of recruiting the patients included in the study.…”

Section: Resultssupporting

confidence: 46%

“…The literature [3,[22][23][24][25][26][27][28][29] describes the existence in the group of severe aortic stenosis with preserved ejection fraction, of a subgroup of patients with aortic orifice area less than 1cm 2 , but who present maximal transvalvular systolic velocities lower than 4 m/s at the echocardiographic evaluation. According to these studies, the explanation of the phenomenon would mainly consist of the existence of important concentric left ventricular hypertrophy that associates a small ventricular cavity and a low systolic flow.…”

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confidence: 99%

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Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient

Nanea¹,

Nicolae²,

Ilieșiu³

et al. 2019

Rev. Chim.

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Purpose of the study: echocardiographic evaluation of the form of degenerative aortic stenosis (DAS) with preserved ejection fraction (EF) and low transvalvular gradient, in order to formulate the indication of valvular prosthesis as early as possible; retrospective observational study that includes patients admitted or sent for ambulatory evaluation by other medical services. The echocardiographic parameters used: systolic and diastolic indices, tissue and spectral, mitral and tricuspid veins, aortic orifice area, maximal aortic systolic velocity, maximal and medium aortic transvalvular gradient, myocardial mass index, volume of left atrium, left ventricular (LV) thickness. 42 patients with severe DAS and preserved EF, average age 71.7�3.85 years. Two groups were isolated: A - with increased gradient (22 patients) and B - with low gradient (20 patients). The gender distribution was comparable: women representing 33% in group A versus 30% in group B. The average age of women in both groups was higher than that of the men: in group A: 72�8 years in the case of women vs. 67�6 years in the case of men and in group B 72�3.5 years in women vs. 68�6 years in men. Apical displacement of the mitral ring: 14�2mm in lot A vs. 11�2mm in lot B. Myocardial mass index: 120 � 9g/m2 in lot A vs. 126 � 12g/m2 in lot B. Left ventricular filling ratio E/e�: 8�2 in lot A vs. 13�2 in lot B; maximum aortic systolic velocity: 4.3�0.9m/s in lot A vs. 3.1�0.8m/s in lot B; maximum gradient: 73.9�10mmHg in lot A vs. 37�12mmHg in lot B; aortic orifice area: 0.80�10.5 in lot A vs. 0.79�0.07 in lot B. Statistical analysis shows the Pearson correlation index r with the highest values of 95% at the significance threshold between the aortic orifice area and the valve opening (r=0.87), the ratio E/e� (r=-0.85) and diastolic thickness of the posterior wall of the aortic left ventricle (r = 0.78). Aortic stenosis with preserved ejection fraction and low gradient was more common in men. The filling ratio E/e� was increased (13 � 2) in group B, suggesting the increase of filling pressures of LV in patients with DAS and low transvalvular gradient. Tissue spectral systolic and longitudinal velocities were lower in group B, suggesting the onset of systolic LV dysfunction. The aortic valve opening and the E/e� ratio showed the highest correlation coefficient with the area of the aortic orifice in both groups. The myocardial mass index and the thickness of the walls of the LV cavity are similar in the two groups, suggesting that the reduction of the LV cavity through hypertrophy may not explain, at least in totality, the form of DAS with low gradient and preserved ejection fraction.

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Section: Resultssupporting

confidence: 46%

mentioning

confidence: 99%

Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient

Nanea¹,

Nicolae²,

Ilieșiu³

et al. 2019

Rev. Chim.

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“…Cuando se revisa la situación media de flujo transvalvular en la literatura referente a la estenosis aórtica severa de bajo flujo y bajo gradiente desde esta perspectiva 4 , destaca la frecuente mala clasificación de la situación de flujo transvalvular que supone el empleo del criterio actualmente aceptado, no siendo infrecuente que la situación de flujo transvalvular definida según gasto, índice cardiaco o tasa de flujo transvalvular sea normal en pacientes clasificados como bajo flujo según el criterio de iVS. Y lo contrario, la presencia de tasas de flujo transvalvular medias bajas en los grupos de referencia empleados en los que se esperaría que esta fuese normal.…”

Section: El íNdice De Volumen Latido Como Criterio De Bajo Flujounclassified

“…Es especialmente relevante tener en cuenta la situación hemodinámica básica de presión arterial, frecuencia cardíaca y ritmo en el momento de obtener los índices de severidad hemodinámica, pues estos pueden modificar los valores obtenidos y deben ser normalizados antes de la evaluación de la severidad. No deja de sorprender que con frecuencia no sea posible conocer la situación hemodinámica básica de los diferentes grupos en los estudios referentes a la entidad que nos ocupa, a pesar de restringirse el análisis a las revistas monográficas de cardiología de mayor impacto 4 .…”

Section: Otras Consideracionesunclassified

Estenosis aórtica «severa» de bajo gradiente y bajo flujo paradójico: reflexiones sobre la leyenda del Yeti en la cardiología moderna y sus alrededores

Valencia-Serrano

2016

Cardiocore

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Paradoxical Low Flow-Low Gradient Severe Aortic Stenosis: A Clinical Entity or a Scientific Artifact

Cited by 2 publications

References 0 publications

Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient

Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient

Estenosis aórtica «severa» de bajo gradiente y bajo flujo paradójico: reflexiones sobre la leyenda del Yeti en la cardiología moderna y sus alrededores

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