The evaluation of aortic stenosis, how the new guidelines are implemented across Europe: a survey by EACVI

Michalski, Błażej; Dweck, Marc R; Marsan, Nina Ajmone; Cameli, Matteo; D’Andrea, Antonello; Carvalho, Ricardo Fontes; Holte, Espen; Podlesnikar, Tomaž; Manka, Robert; Haugaa, Kristina H.

doi:10.1093/ehjci/jeaa009

Cited by 25 publications

(15 citation statements)

References 19 publications

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“…A recent survey evidenced that only half of the centers reported the routine calculation of the SVi in these patients in Europe, indicating limited adherence to ESC guidelines. [50] Despite these perplexities, no prospective randomized trial has still conducted to evaluate the optimal management of patients with LG-AS. Of note, there are also some contemporary data suggesting that moderate AS (i.e., pseudo-severe AS) may not be a benign stage in the evolution of the disease as the conventional wisdom tells us almost in patients at an advanced stage of cardiac damage and high risk of rapid progression of AS.…”

Section: Discussionmentioning

confidence: 99%

Discordant echocardiographic grading in low gradient aortic stenosis (DEGAS study) from the Italian society of echocardiography and cardiovascular imaging research network: Rationale and study design

Barbieri

Antonini‐Canterin

Pepi

et al. 2020

J Cardiovasc Echography

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RationalePatients with low-gradient aortic stenosis (LG-AS) are among the most challenging encountered in patients with valvular heart disease. The two main goals for optimal risk stratification and therapeutic management of patients with LG-AS are (i) to accurately discriminate severe aortic stenosis (SAS) versus Background: Low-gradient aortic stenosis (LG-AS) is characterized by the combination of an aortic valve area compatible with severe stenosis and a low transvalvular mean gradient with low-flow state (i.e., indexed stroke volume <35 mL/m 2 ) in the presence of reduced (classical low-flow AS) or preserved (paradoxical low-flow AS) ejection fraction. Furthermore, the occurrence of a normal-flow LG-AS is still advocated by many authors. Within this diagnostic complexity, the diagnosis of severe AS remains challenging. Objective: The general objective of the Discordant Echocardiographic Grading in Low-gradient AS (DEGAS Study) study will be to assess the prevalence of true severe AS in this population and validate new parameters to improve the assessment and the clinical decision-making in patients with LG-AS. Methods and Analyses: The DEGAS Study of the Italian Society of Echocardiography and Cardiovascular Imaging is a prospective, multicenter, observational diagnostic study that will enroll consecutively adult patients with LG-AS over 2 years. AS severity will be ideally confirmed by a multimodality approach, but only the quantification of calcium score by multidetector computed tomography will be mandatory. The primary clinical outcome variable will be 12-month all-cause mortality. The secondary outcome variables will be (i) 30-day mortality (for patients treated by Surgical aortic valve replacement or TAVR); (ii) 12-month cardiovascular mortality; (iii) 12-month new major cardiovascular events such as myocardial infarction, stroke, vascular complications, and rehospitalization for heart failure; and (iv) composite endpoint of cardiovascular mortality and hospitalization for heart failure. Data collection will take place through a web platform (REDCap), absolutely secure based on current standards concerning the ethical requirements and data integrity.

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Section: Discussionmentioning

confidence: 99%

Discordant echocardiographic grading in low gradient aortic stenosis (DEGAS study) from the Italian society of echocardiography and cardiovascular imaging research network: Rationale and study design

Barbieri

Antonini‐Canterin

Pepi

et al. 2020

J Cardiovasc Echography

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“…Recently TAVI is also recommended for patients with intermediate surgical risk. Currently, publish literature also supports TAVI implantation in low risk patients as non-inferior to surgical therapy [55,56].…”

Section: Management Of Aortic Valve Stenosismentioning

confidence: 97%

Aortic Valve Disease: State of the Art

Gamel¹

2021

Advances in Complex Valvular Disease

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Aortic valve replacement is the most commonly performed valve operation. It has been shown to be an effective therapy in all age groups, including the very elderly (age > 90 years). The most common etiologies for aortic stenosis are calcific degeneration, rheumatic disease, and congenital bicuspid valves. The most common causes of pure aortic regurgitation include annuloaortic ectasia and associated dilation of the aortic root, endocarditis, aortic dissection, and rheumatic disease. The indications for surgery depend on the pathophysiology and symptoms. The choice of the prosthesis can be difficult and depends on multiple clinical and lifestyle considerations. Early and late outcomes are generally quite good, even in high-risk patients.

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“…The importance of a careful and comprehensive multi-window acquisition cannot be emphasized enough, since in up to 50% of patients with AS the peak velocity is obtained in a right parasternal view (37,39,40). However, a recent EACVI survey including 125 centers from 32 countries (87% of them tertiary/university high-volume centers) showed that almost half of them did not routinely obtained measurements from the right parasternal view (41). Therefore, before moving to advanced non-invasive imaging, it is fundamental to ensure an optimal echocardiographic acquisition ( Figure 3).…”

Section: Validation Of Rest Echocardiographic Parametersmentioning

confidence: 99%

Multimodality Imaging for Discordant Low-Gradient Aortic Stenosis: Assessing the Valve and the Myocardium

Guzzetti

Annabi

Clavel

2020

Front. Cardiovasc. Med.

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Aortic stenosis (AS) is a disease of the valve and the myocardium. A correct assessment of the valve disease severity is key to define the need for aortic valve replacement (AVR), but a better understanding of the myocardial consequences of the increased afterload is paramount to optimize the timing of the intervention. Transthoracic echocardiography remains the cornerstone of AS assessment, as it is universally available, and it allows a comprehensive structural and hemodynamic evaluation of both the aortic valve and the rest of the heart. However, it may not be sufficient as a significant proportion of patients with severe AS presents with discordant grading (i.e., an AVA ≤ 1 cm2 and a mean gradient <40 mmHg) which raises uncertainty about the true severity of AS and the need for AVR. Several imaging modalities (transesophageal or stress echocardiography, computed tomography, cardiovascular magnetic resonance, positron emission tomography) exist that allow a detailed assessment of the stenotic aortic valve and the myocardial remodeling response. This review aims to provide an updated overview of these multimodality imaging techniques and seeks to highlight a practical approach to help clinical decision making in the challenging group of patients with discordant low-gradient AS.

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The evaluation of aortic stenosis, how the new guidelines are implemented across Europe: a survey by EACVI

Cited by 25 publications

References 19 publications

Discordant echocardiographic grading in low gradient aortic stenosis (DEGAS study) from the Italian society of echocardiography and cardiovascular imaging research network: Rationale and study design

Discordant echocardiographic grading in low gradient aortic stenosis (DEGAS study) from the Italian society of echocardiography and cardiovascular imaging research network: Rationale and study design

Aortic Valve Disease: State of the Art

Multimodality Imaging for Discordant Low-Gradient Aortic Stenosis: Assessing the Valve and the Myocardium

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