Stress Echocardiography to Assess Stenosis Severity and Predict Outcome in Patients With Paradoxical Low-Flow, Low-Gradient Aortic Stenosis and Preserved LVEF

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• 作者：Marie-Annick Clavel ; DVM ; PhD^? ; Pierre Vladimir Ennezat ; MD^&dagger ; ; Sylvestre Maré ; chaux ; MD^&dagger ; ; Jean G. Dumesnil ; MD^? ; Romain Capoulade ; MS^? ; Zeineb Hachicha ; MD^? ; Patrick Mathieu ; MD^? ; Annaï ; k Bellouin ; MD^&dagger ; ; Sé ; bastien Bergeron ; MD^? ; Patrick Meimoun ; MD^&Dagger ; ; Marie Arsenault ; MD^? ; Thierry Le Tourneau ; MD^§ ; ; Agnè ; s Pasquet ; MD^¡Î ; Christian Couture ; MD^? ; Philippe Pibarot ; DVM ; PhD^? ; ^{philippe.pibarot@med.ulaval.ca}
• 关键词：aortic stenosis ; dobutamine stress echocardiography ; exercise stress echocardiography ; low-flow aortic stenosis
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2013
• 出版时间：February, 2013
• 年：2013
• 卷：6
• 期：2
• 页码：175-183
• 全文大小：483 K

文摘

The objective of this study was to examine the value of stress-echocardiography in patients with paradoxical low-flow, low-gradient (PLFLG) aortic stenosis (AS). The projected aortic valve area (AVA_Proj) at a normal flow rate was calculated in 55 patients with PLFLG AS. In the subset of patients (n = 13) who underwent an aortic valve replacement within 3 months after stress echocardiography, AVA_Proj correlated better with the valve weight compared to traditional resting and stress echocardiographic parameters of AS severity (AVA_Proj: r = ?0.78 vs. other parameters: r = 0.46 to 0.56). In the whole group (N = 55), 18 (33 % ) patients had an AVA_Proj >1.0 cm², being consistent with the presence of pseudo severe AS. The AVA_Proj was also superior to traditional parameters of stenosis severity for predicting outcomes (hazard ratio: 1.32/0.1 cm² decrease in AVA_Proj). In patients with PLFLG AS, the measurement of AVA_proj derived from stress echocardiography is helpful to determine the actual severity of the stenosis and predict risk of adverse events.