Systolic Volume Index by Doppler Echocardiography Is an Useful Marker for Stratification and Prognostic Evaluation in Patients With Severe Aortic Stenosis and Preserved Ejection Fraction

Melis, Gaspar; Frontera, Guillem; Caldentey, Guillem; Sahuquillo, Ana; Fernández-Palomeque, Carlos; Forteza, J.; Bethencourt, Armando; Sáez-Ibarra, José I.; Bonnín, Oriol

doi:10.1016/j.rec.2012.09.004

Cited by 9 publications

(18 citation statements)

References 28 publications

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“…In addition, we found that myocardial fibrosis assessed by MRI was common in the NFLG group although markers of filling pressure (E/e′ and BNP) were lower than in patients with high gradients. These findings corroborate data from previous studies [5][6][7] and further extend them because we found that despite differences in remodeling, patients with NFLG tend to have similar symptoms as NFHG patients. The less extensive valvular pathology with less LV/LA remodeling seen in NFLG and suggest that this phenotype of AS is a milder form than NFHG with the same symptom burden.…”

supporting

confidence: 92%

“…Not infrequently, however, patients present with apparently normal SVi, a morphologically severely stenotic valve, an estimated aortic valve area (AVA <1 cm 2 ), but only a moderately elevated mean gradient (<40 mm Hg). This condition termed normal-flow low-gradient (NFLG) AS is relatively common, with an estimated prevalence among patients with AS ranging from 13% to 31% [2][3][4][5][6][7] and associated with a favorable prognosis compared with other AS groups. 2,5,7,8 The benefit of AVR in these patients is controversial.…”

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confidence: 99%

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Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

Carter-Storch

Møller

Christensen

et al. 2017

Circ: Cardiovascular Imaging

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Background-Severe aortic stenosis (AS) most often presents with reduced aortic valve area (<1 cm 2 ), normal stroke volume index (≥35 mL/m 2 ), and either high mean gradient (≥40 mm Hg; normal-flow high-gradient AS) or low mean gradient (normal-flow low-gradient [NFLG] AS). The benefit of aortic valve replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit. Methods and Results-Eighty-seven consecutive patients with reduced aortic valve area and normal stroke volume index undergoing AVR underwent echocardiography, magnetic resonance imaging, a 6-minute walk test, and measurement of natriuretic peptides before and 1 year after AVR. Myocardial fibrosis was assessed from magnetic resonance imaging.Patients were stratified as NFLG or normal-flow high-gradient. In total, 33 patients (38%) had NFLG. Before AVR, they were characterized by similar symptom burden but less severe AS measured by aortic valve area index ( Furthermore, NFLG patients experienced less reverse remodeling but the same symptomatic benefit. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02316587.

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supporting

confidence: 92%

mentioning

confidence: 99%

Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

Carter-Storch

Møller

Christensen

et al. 2017

Circ: Cardiovascular Imaging

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“…Moreover, these patients had larger left atrial dimension and volume, while RWT in the HMG/LF group, as revealed in our study and by a number of other investigators. 20,21 Diastolic function appears early in the course of AS, 23,24 and, in our study, it was more advanced in the HMG/LF group compared with the HMG/NF group. It was expressed as bigger left atria, lower mitral flow E velocities, and higher values of the E/E'.…”

Section: Resultssupporting

confidence: 47%

Clinical outcome, echocardiographic assessment, neurohormonal and collagen turnover markers in low-fl ow severe aortic stenosis with high transvalvular gradient

Piestrzeniewicz¹,

Łuczak²,

Maciejewski³

et al. 2014

Polish Archives of Internal Medicine

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INTRODUCTION Patients with severe aortic stenosis (AS), high mean gradient (HMG), and preserved left ventricular ejection fraction (LVEF) may present with paradoxical "low flow" (LF). OBJECTIVES The aim of the study was to assess the potential effect of cardiac collagen metabolism on the HMG/LF phenomenon in patients with severe AS and to determine a clinical and echocardiographic pattern of these patients. PATIENTS AND METHODS We assessed a clinical status of 89 patients, aged over 64 years, with severe AS, HMG, and preserved LVEF (≥50%). Cardiac structure and function as well as systemic arterial hemodynamics were assessed with echocardiography, conventional Doppler, and tissue Doppler imaging. Moreover, plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), procollagen III N-terminal propeptide (PIIINP), carboxyterminal telopeptide of collagen type I, matrix metallopeptidase 9, and inhibitor of matrix metalloproteinase type 1 were evaluated. We analyzed 2 groups of patients: with normal flow (stroke volume index [SVI], ≥35 ml/m 2 ; n = 70) and with LF (SVI, <35 ml/m 2 ; n = 19). RESULTS Patients with LF were older, had a larger left atrium and left atrial volume index, smaller aortic valve area, lower energy loss index, stroke work, mitral flow E velocity, mitral annular E' and S' velocities and systemic arterial compliance, higher relative left ventricular wall thickness, E/E', systemic arterial resistance and valvulo-arterial impedance. We observed a correlation between SVI and NT-proBNP, PIIINP, and selected parameters of cardiac structure and function. CONCLUSIONS In patients with severe AS, HMG and preserved LVEF, the LF is related to a more severe obstruction, altered aortic hemodynamics, cardiac dysfunction, and higher blood levels of NT-proBNP. An inverse association between PIIINP and SVI may indicate enhanced tissue fibrosis as an underlying pathology.

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“…Indeed, Hachicha and colleagues initially described “paradoxical” low‐flow AS (PLF AS) and subsequent studies confirmed that PLF AS is not uncommon in clinical practice . Moreover, patients with PLF AS generally have worse clinical outcomes than patients with normal flow AS (NF AS) and PLF AS patients also benefit from valve replacement when symptomatic …”

mentioning

confidence: 99%

“…[4][5][6][7] Moreover, patients with PLF AS generally have worse clinical outcomes than patients with normal flow AS (NF AS) and PLF AS patients also benefit from valve replacement when symptomatic. [8][9][10][11] Investigations of the potential mechanisms of low flow despite apparently normal systolic function have focused on the left heart and have implicated reduced left ventricular (LV) cavity size from remodeling and hypertrophy, intrinsic LV systolic dysfunction not measured by LVEF, and increased systemic afterload. 4,7,[12][13][14] However, the role of right ventricular (RV) function in patients with severe AS and preserved LVEF is not known.…”

mentioning

confidence: 99%

Right Ventricular Function Is Associated with Left Ventricular Stroke Volume in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction

Charlton

Slomka

et al. 2015

Echocardiography

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Systolic Volume Index by Doppler Echocardiography Is an Useful Marker for Stratification and Prognostic Evaluation in Patients With Severe Aortic Stenosis and Preserved Ejection Fraction

Cited by 9 publications

References 28 publications

Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

Clinical outcome, echocardiographic assessment, neurohormonal and collagen turnover markers in low-fl ow severe aortic stenosis with high transvalvular gradient

Right Ventricular Function Is Associated with Left Ventricular Stroke Volume in Patients with Severe Aortic Stenosis and Preserved Ejection Fraction

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