title: Classification of Aortic Stenosis by Flow and Gradient Patterns Provides Insights into the Pathophysiology of Disease.
abstract: Different patterns of flow and valve gradients can lead to diagnostic uncertainty about the severity of aortic stenosis (AS). Consecutive patients with severe AS (valve area <1 cm(2)) underwent echocardiography and computed tomography. Patients were classified into 4 groups (high-gradient/normal flow [HGNF], high-gradient/low flow [HGLF], low-gradient/normal flow [LGNF], and low-gradient/low flow [LGLF]). Low flow was defined as stroke volume index <35 mL/m(2) and low gradient as a mean aortic gradient <40 mm Hg. Aortic valve calcification (AVC) was calculated using the Agatston score. Of 181 patients, 56, 30, 46, and 49 had HGNF, HGLF, LGNF and LGLF with median AVC of 2048, 2015, 1366, and 1178 AU/m(2) (P < .0001) and valvuloarterial impedance of 4.5, 6.4, 4.2, and 5.9, respectively (P < .0001). Among those with LGLF, AVC was lower in patients with preserved compared to reduced left ventricular ejection fraction (1018 vs 2550 AU/m(2); P < .0001), but valvuloarterial impedance was similar (P = .33). The LGLF AS with preserved ejection fraction is associated with lower AVC and may identify patients with less severe AS in association with an adaptive ventricular response to high afterload.
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom Echocardiography Laboratory, Harefield Hospital, London, United Kingdom sanjeev144@hotmail.com.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhattacharyya
authors.affiliation: Department of Imaging, Harefield Hospital, London, United Kingdom.
authors.forename: Tarun
authors.initials: T
authors.lastname: Mittal
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom.
authors.forename: Mayavan
authors.initials: M
authors.lastname: Abayalingam
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom.
authors.forename: Tito
authors.initials: T
authors.lastname: Kabir
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom.
authors.forename: Miles
authors.initials: M
authors.lastname: Dalby
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom.
authors.forename: John G
authors.initials: JG
authors.lastname: Cleland
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom Echocardiography Laboratory, Harefield Hospital, London, United Kingdom.
authors.forename: Aigul
authors.initials: A
authors.lastname: Baltabaeva
authors.affiliation: Department of Cardiology, Harefield Hospital, London, United Kingdom Echocardiography Laboratory, Harefield Hospital, London, United Kingdom.
authors.forename: Shelley
authors.initials: S
authors.lastname: Rahman Haley
mesh_terms: D000222:Adaptation, Physiological; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001783:Blood Flow Velocity; D002114:Calcinosis / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018619:Echocardiography, Doppler, Pulsed; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013318:Stroke Volume; D016277:Ventricular Function, Left
keywords: aortic stenosis; cardiac computed tomography; echocardiography; valve calcification