title: Postextrasystolic potentiation in low-gradient, severe aortic stenosis: a poor man's stress echo?
abstract: An elderly man with dyspnea and syncope was found to have severe aortic stenosis (AS) by the continuity equation, despite a transaortic gradient that was only moderately elevated, in the setting of severe left ventricular dysfunction. The transaortic gradient increased during postextrasystolic beats, suggesting that his that his AS was truly severe; this was confirmed by dobutamine echocardiography. He underwent transcatheter aortic-valve replacement (TAVR), with subsequent improvement in left ventricular systolic function. The diagnostic and prognostic significance of postextrasystolic potentiation, with associated increase in aortic stenosis gradient, deserves renewed attention in the TAVR era.
authors.affiliation: Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois 60637, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Bhave
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
authors.forename: Atman P
authors.initials: AP
authors.lastname: Shah
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D014665:Vasodilator Agents; D004280:Dobutamine
keywords: Doppler echocardiography; aortic stenosis; aortic valve replacement