title: Stress echocardiography to assess stenosis severity and predict outcome in patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF.
abstract: 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 (AVAProj) 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 cm(2), 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 cm(2) 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.
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada.
authors.forename: Marie-Annick
authors.initials: MA
authors.lastname: Clavel
authors.forename: Pierre Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.forename: Jean G
authors.initials: JG
authors.lastname: Dumesnil
authors.forename: Romain
authors.initials: R
authors.lastname: Capoulade
authors.forename: Zeineb
authors.initials: Z
authors.lastname: Hachicha
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
authors.forename: Annaïk
authors.initials: A
authors.lastname: Bellouin
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bergeron
authors.forename: Patrick
authors.initials: P
authors.lastname: Meimoun
authors.forename: Marie
authors.initials: M
authors.lastname: Arsenault
authors.forename: Thierry
authors.initials: T
authors.lastname: Le Tourneau
authors.forename: Agnès
authors.initials: A
authors.lastname: Pasquet
authors.forename: Christian
authors.initials: C
authors.lastname: Couture
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D002316:Cardiotonic Agents; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004280:Dobutamine; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine