Low-Flow, Low-Gradient Severe Aortic Stenosis Despite Normal Ejection Fraction Is Associated with Severe Left Ventricular Dysfunction as Assessed by Speckle-Tracking Echocardiography: A Multicenter Study
Jérôme Adda,Christopher Mielot,Roch Giorgi,Frédéric Cransac,Xavier Zirphile,Erwan Donal,Catherine Sportouch-Dukhan,Patricia Reant,Stéphane Laffitte,Stéphane Cade,Yvan Le Dolley,Franck Thuny,Nathalie Touboul,Cécile Lavoute,Jean-François Avierinos,Patrizio Lancellotti,Gilbert Habib +16 more
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LFLG AS is observed in 9% of patients with severe AS and normal ejection fraction and is associated with high global afterload and reduced longitudinal systolic function.Abstract:
BACKGROUND: Low-flow low-gradient (LFLG) is sometimes observed in severe aortic stenosis (AS) despite normal ejection fraction, but its frequency and mechanisms are still debated. We aimed to describe the characteristics of patients with LFLG AS and assess the presence of longitudinal left ventricular dysfunction in these patients. METHODS AND RESULTS: In a multicenter prospective study, 340 consecutive patients with severe AS and normal ejection fraction were studied. Longitudinal left ventricular function was assessed by 2D-strain and global afterload by valvulo-arterial impedance. Patients were classified according to flow and gradient: low flow was defined as a stroke volume index ≤35 mL/m(2), low gradient as a mean gradient ≤40 mm Hg. Most patients (n=258, 75.9%) presented with high-gradient AS, and 82 patients (24.1%) with low-gradient AS. Among the latter, 52 (15.3%) presented with normal flow and low gradient and 30 (8.8%) with LFLG. As compared with normal flow and low gradient, patients with LFLG had more severe AS (aortic valve area=0.7±0.12 cm(2) versus 0.86±0.14 cm(2)), higher valvulo-arterial impedance (5.5±1.1 versus 4±0.8 mm Hg/mL/m(2)), and worse longitudinal left ventricular function (basal longitudinal strain=-11.6±3.4 versus -14.8±3%; P<0.001 for all). CONCLUSIONS: LFLG AS is observed in 9% of patients with severe AS and normal ejection fraction and is associated with high global afterload and reduced longitudinal systolic function. Patients with normal-flow low-gradient AS are more frequent and present with less severe AS, normal afterload, and less severe longitudinal dysfunction. Severe left ventricular longitudinal dysfunction is a new explanation to the concept of LFLG AS.read more
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The Complex Nature of Discordant Severe Calcified Aortic Valve Disease Grading : New Insights From Combined Doppler Echocardiographic and Computed Tomographic Study
Marie-Annick Clavel,David Messika-Zeitoun,Philippe Pibarot,Shivani R. Aggarwal,Joseph Malouf,Phillip A. Araoz,Hector I. Michelena,Caroline Cueff,Eric Larose,Romain Capoulade,Alec Vahanian,Maurice Enriquez-Sarano +11 more
TL;DR: The clinical yield of AVC quantification by MDCT to diagnose and manage these complex patients is emphasized, with at least one-half of the patients with discordant low gradient present with heavy AVC-load reflective of severe calcified aortic valve disease.
Journal ArticleDOI
Low-Flow, Low-Gradient Aortic Stenosis With Normal and Depressed Left Ventricular Ejection Fraction
TL;DR: The present paper proposes to review the diagnostic and therapeutic management specificities of LF-LG AS with and without depressed LV function.
Journal ArticleDOI
Impact of Aortic Valve Calcification, as Measured by MDCT, on Survival in Patients With Aortic Stenosis: Results of an International Registry Study
Marie-Annick Clavel,Philippe Pibarot,David Messika-Zeitoun,Romain Capoulade,Joseph Malouf,Shivani Aggarval,Phillip A. Araoz,Hector I. Michelena,Caroline Cueff,Eric Larose,Jordan D. Miller,Alec Vahanian,Maurice Enriquez-Sarano +12 more
TL;DR: This large-scale, multicenter outcomes study of quantitative Doppler echocardiographic and multidetector computed tomography assessment of AS shows that measuring AVC load provides incremental prognostic value for survival beyond clinical and Dopplers echOCardiographic assessment.
Journal ArticleDOI
Flow-Gradient Patterns in Severe Aortic Stenosis With Preserved Ejection Fraction Clinical Characteristics and Predictors of Survival
Mackram F. Eleid,Paul Sorajja,Hector I. Michelena,Joseph F. Malouf,Christopher G. Scott,Patricia A. Pellikka +5 more
TL;DR: In this paper, the prognostic impact of stroke volume using the recently proposed flow-gradient classification was investigated among patients with severe aortic stenosis (AS) and preserved ejection fraction (≥50%).
Journal ArticleDOI
Low-gradient aortic stenosis
TL;DR: Although patients with LF-LG severe AS have worse outcomes than those with high-gradient AS following AVR, they nonetheless display an important survival benefit with this intervention and some studies suggest that transcatheter AVR may be superior to surgical AVR in patients with LS-LG AS.
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