Low flow, low gradient severe aortic stenosis: Diagnosis, treatment and prognosis

EuroIntervention

Volumn 9, Issue , 2013, Pages S38-S42

  Orwat, Stefan ^a   Kaleschke, Gerrit ^a   Kerckhoff, Gregor ^a   Radke, Robert ^a   Baumgartner, Helmut ^a  

^a UNIVERSITY HOSPITAL MÜNSTER   (Germany)

Author keywords

Aortic stenosis; Low flow; Low gradient

Indexed keywords

CALCIUM; DOBUTAMINE;

AORTIC FLOW; AORTIC VALVE DISEASE; AORTIC VALVE STENOSIS; CALCIFICATION; CLINICAL OUTCOME; COMPUTER ASSISTED TOMOGRAPHY; CORONARY ARTERY CALCIUM SCORE; DIAGNOSTIC ERROR; DISEASE SEVERITY; HEART CATHETERIZATION; HEART HEMODYNAMICS; HEART INDEX; HEART LEFT VENTRICLE EJECTION FRACTION; HEART STROKE VOLUME; HEMODYNAMIC PARAMETERS; HUMAN; MEASUREMENT ERROR; MEDICAL DECISION MAKING; NUCLEAR MAGNETIC RESONANCE IMAGING; PROGNOSIS; QUANTITATIVE STUDY; REVIEW; STRESS ECHOCARDIOGRAPHY; TRANSCATHETER AORTIC VALVE IMPLANTATION; AORTA VALVE; AORTA VALVE STENOSIS; DISEASE MANAGEMENT; ECHOCARDIOGRAPHY; ECHOGRAPHY; HEART VALVE REPLACEMENT; HEMODYNAMICS; METHODOLOGY; PATHOPHYSIOLOGY; PHYSIOLOGY; SEVERITY OF ILLNESS INDEX; TREATMENT OUTCOME;

AORTIC VALVE; AORTIC VALVE STENOSIS; CARDIAC CATHETERIZATION; DISEASE MANAGEMENT; ECHOCARDIOGRAPHY; HEART VALVE PROSTHESIS IMPLANTATION; HEMODYNAMICS; HUMANS; PROGNOSIS; SEVERITY OF ILLNESS INDEX; STROKE VOLUME; TREATMENT OUTCOME;

EID: 84903493565     PISSN: 1774024X     EISSN: 19696213     Source Type: Journal    
DOI: 10.4244/EIJV9SSA8     Document Type: Review

References (37)

1. Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC), European Association for Cardio-Thoracic Surgery (EACTS), Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J. 2012;33:2451-96.
2. Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, Iung B, Otto CM, Pellikka PA, Quiñones M, American Society of Echocardiography, European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009;22:1-23; quiz 101-2.
3. Herrmann HC, Pibarot P, Hueter I, Gertz ZM, Stewart WJ, Kapadia S, Tuczu EM, Babaliaros V, Thourani V, Szeto WY, Bavaria JE, Kodali S, Hahn RT, Williams M, Miller DC, Douglas PS, Leon MB. Predictors of Mortality and Outcomes of Therapy in Low-Flow Severe Aortic Stenosis: A Placement of Aortic Transcatheter Valves (PARTNER) Trial Analysis. Circulation. 2013;127:2316-26.
4. Adda J, Mielot C, Giorgi R, Cransac F, Zirphile X, Donal E, Sportouch-Dukhan C, Réant P, Laffitte S, Cade S, Le Dolley Y, Thuny F, Touboul N, Lavoute C, Avierinos JF, Lancellotti P, Habib G. 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. Circ Cardiovasc Imaging. 2012;5:27-35.
5. Lancellotti P, Magne J, Donal E, Davin L, O'Connor K, Rosca M, Szymanski C, Cosyns B, Piérard LA. Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification. J Am Coll Cardiol. 2012;59:235-43.
6. Carabello BA, Green LH, Grossman W, Cohn LH, Koster JK, Collins JJ. Hemodynamic determinants of prognosis of aortic valve replacement in critical aortic stenosis and advanced congestive heart failure. Circulation. 1980;62:42-8.
7. deFilippi CR, Willett DL, Brickner ME, Appleton CP, Yancy CW, Eichhorn EJ, Grayburn PA. Usefulness of dobutamine echocardiography in distinguishing severe from nonsevere valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradients. Am J Cardiol. 1995;75:191-4.
8. Monin JL, Quéré JP, Monchi M, Petit H, Baleynaud S, Chauvel C, Pop C, Ohlmann P, Lelguen C, Dehant P, Tribouilloy C, Guéret P. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003;108:319-24.
9. Nishimura RA, Grantham JA, Connolly HM, Schaff HV, Higano ST, Holmes DR. Low-output, low-gradient aortic stenosis in patients with depressed left ventricular systolic function: the clinical utility of the dobutamine challenge in the catheterization laboratory. Circulation. 2002;106:809-13.
10. Fougères E, Tribouilloy C, Monchi M, Petit-Eisenmann H, Baleynaud S, Pasquet A, Chauvel C, Metz D, Adams C, Rusinaru D, Guéret P, Monin JL. Outcomes of pseudo-severe aortic stenosis under conservative treatment. Eur Heart J. 2012;33:2426-33.
11. Clavel MA, Burwash IG, Mundigler G, Dumesnil JG, Baumgartner H, Bergler-Klein J, Sénéchal M, Mathieu P, Couture C, Beanlands R, Pibarot P. Validation of conventional and simplified methods to calculate projected valve area at normal flow rate in patients with low flow, low gradient aortic stenosis: the multicenter TOPAS (True or Pseudo Severe Aortic Stenosis) study. J Am Soc Echocardiogr. 2010;23:380-6.
12. Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, Duval X, Iung B, Enriquez-Sarano M, Vahanian A, Messika-Zeitoun D. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart. 2011;97:721-6.
13. Carabello BA. The symptoms of aortic stenosis: a step closer to understanding their cause. JACC Cardiovasc Imaging. 2013;6:147-9.
14. Pibarot P, Dumesnil JG. Low-flow, low-gradient aortic stenosis with normal and depressed left ventricular ejection fraction. J Am Coll Cardiol. 2012;60:1845-53.
15. Blitz LR, Gorman M, Herrmann HC. Results of aortic valve replacement for aortic stenosis with relatively low transvalvular pressure gradients. Am J Cardiol. 1998;81:358-62.
16. Ben-Dor I, Maluenda G, Iyasu GD, Laynez-Carnicero A, Hauville C, Torguson R, Okubagzi P, Xue Z, Goldstein SA, Lindsay J, Satler LF, Pichard AD, Waksman R. Comparison of outcome of higher versus lower transvalvular gradients in patients with severe aortic stenosis and low. Am J Cardiol. 2012;109:1031-7.
17. Tribouilloy C, Lévy F, Rusinaru D, Guéret P, Petit-Eisenmann H, Baleynaud S, Jobic Y, Adams C, Lelong B, Pasquet A, Chauvel C, Metz D, Quéré JP, Monin JL. Outcome after aortic valve replacement for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol. 2009;53:1865-73.
18. Hahn RT, Pibarot P, Stewart WJ, Weissman NJ, Gopalakrishnan D, Keane MG, Anwaruddin S, Wang Z, Bilsker M, Lindman BR, Herrmann HC, Kodali SK, Thourani VH, Svensson LG, Akin JJ, Anderson WN, Leon M, Douglas PS. Comparison of Transcatheter and Surgical Aortic Valve Replacement in Severe Aortic Stenosis: A Longitudinal Study of Echo Parameters in Cohort A of the PARTNER Trial. J Am Coll Cardiol. 2013 Apr 23. [Epub ahead of print]
19. Kulik A, Burwash IG, Kapila V, Mesana TG, Ruel M. Long-term outcomes after valve replacement for low-gradient aortic stenosis: impact of prosthesis-patient mismatch. Circulation. 2006;114:I553-8.
20. Flett AS, Sado DM, Quarta G, Mirabel M, Pellerin D, Herrey AS, Hausenloy DJ, Ariti C, Yap J, Kolvekar S, Taylor AM, Moon JC. Diffuse myocardial fibrosis in severe aortic stenosis: an equilibrium contrast cardiovascular magnetic resonance study. Eur Heart J Cardiovasc Imaging. 2012;13:819-26.
21. Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007;115:2856-64.
22. Dumesnil JG, Pibarot P, Carabello B. Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment. Eur Heart J. 2010;31:281-9.
23. Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R, Garcia D, Pibarot P. Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol. 2005;46:291-8.
24. Eleid MF, Nishimura RA, Borlaug BA, Sorajja P. Invasive Measures of Afterload in Low Gradient Severe Aortic Stenosis with Preserved Ejection Fraction. Circ Heart Fail. 2013 May 24. [Epub ahead of print]
25. Baumgartner H, Kratzer H, Helmreich G, Kuehn P. Determination of aortic valve area by Doppler echocardiography using the continuity equation: a critical evaluation. Cardiology. 1990;77:101-11.
26. Michelena HI, Margaryan E, Miller FA, Eleid M, Maalouf J, Suri R, Messika-Zeitoun D, Pellikka PA, Enriquez-Sarano M. Inconsistent echocardiographic grading of aortic stenosis: is the left ventricular outflow tract important? Heart. 2013;99:921-31.
27. Gaspar T, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Shiran A. Three-dimensional imaging of the left ventricular outflow tract: impact on aortic valve area estimation by the continuity equation. J Am Soc Echocardiogr. 2012;25:749-57.
28. Carabello BA. Clinical practice. Aortic stenosis. N Engl J Med. 2002;346:677-82.
29. Minners J, Allgeier M, Gohlke-Baerwolf C, Kienzle RP, Neumann FJ, Jander N. Inconsistent grading of aortic valve stenosis by current guidelines: haemodynamic studies in patients with apparently normal left ventricular function. Heart. 2010;96:1463-8.
30. Minners J, Allgeier M, Gohlke-Baerwolf C, Kienzle RP, Neumann FJ, Jander N. Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis. Eur Heart J. 2008;29:1043-8.
31. Zoghbi WA. Low-gradient "severe" aortic stenosis with normal systolic function: time to refine the guidelines? Circulation. 2011;123:838-40.
32. Herrmann S, Störk S, Niemann M, Lange V, Strotmann JM, Frantz S, Beer M, Gattenlöhner S, Voelker W, Ertl G, Weidemann F. Low-gradient aortic valve stenosis myocardial fibrosis and its influence on function and outcome. J Am Coll Cardiol. 2011;58:402-12.
33. Lancellotti P, Donal E, Magne J, O'Connor K, Moonen ML, Cosyns B, Piérard LA. Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study. Eur J Echocardiogr. 2010;11:537-43.
34. Clavel MA, Ennezat PV, Maréchaux S, Dumesnil JG, Capoulade R, Hachicha Z, Mathieu P, Bellouin A, Bergeron S, Meimoun P, Arsenault M, Le Tourneau T, Pasquet A, Couture C, Pibarot P. Stress echocardiography to assess stenosis severity and predict outcome in patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF. JACC Cardiovasc Imaging. 2013;6:175-83.
35. Clavel MA, Dumesnil JG, Capoulade R, Mathieu P, Sénéchal M, Pibarot P. Outcome of patients with aortic stenosis, small valve area, and low-flow, low-gradient despite preserved left ventricular ejection fraction. J Am Coll Cardiol. 2012;60:1259-67.
36. Levy F, Laurent M, Monin JL, Maillet JM, Pasquet A, Le Tourneau T, Petit-Eisenmann H, Gori M, Jobic Y, Bauer F, Chauvel C, Leguerrier A, Tribouilloy C. Aortic valve replacement for low-flow/low-gradient aortic stenosis operative risk stratification and long-term outcome: a European multicenter study. J Am Coll Cardiol. 2008;51:1466-72.
37. Jander N, Minners J, Holme I, Gerdts E, Boman K, Brudi P, Chambers JB, Egstrup K, Kesäniemi YA, Malbecq W, Nienaber CA, Ray S, Rossebø A, Pedersen TR, Skjaerpe T, Willenheimer R, Wachtell K, Neumann FJ, Gohlke-Bärwolf C. Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction. Circulation. 2011;123:887-95.