Resolving Apparent Inconsistencies Between Area, Flow, and Gradient Measurements in Patients With Aortic Valve Stenosis and Preserved Left Ventricular Ejection Fraction

Resolving Apparent Inconsistencies Between Area, Flow, and Gradient Measurements in Patients With... Inconsistencies between area (aortic valve area [AVA])-flow-gradient are common during the echocardiographic assessment of aortic stenosis (AS). This study was conducted to investigate the importance of these inconsistencies and the impact of 3 methods to resolve these inconsistencies. The study population consisted of 327 patients (age: 76.3 ± 8.6 years, 49.5% males) with severe AS (SAS) (AVA ≤ 1 cm2) and preserved left ventricular ejection fraction (≥50%). Inconsistent findings between AVA, flow, and mean gradient (MG) were observed in 78 (23.9%) patients with low flow and a high MG, 52 (15.9%) patients with normal flow and a low MG, and 37 (11.3%) patients with a low flow and a low MG. Using stroke volume index by catheterization for AVA recalculation showed the greatest effect to resolve inconsistencies in the low flow and a high MG group (85%). Decreasing the AVA cut-off values for SAS to ≤0.8 cm2 resulted in a shift from SAS to moderate AS in 36 patients (69%) in the normal flow and a low MG. Indexing AVA to body surface area had only a minor impact on reclassification. In conclusion, in patients with SAS and preserved left ventricular ejection fraction, the majority of area-flow-gradient inconsistencies at echocardiography can be resolved by correcting errors in stroke volume index measurements by alternative techniques and by redefining the cut-off value for SAS to ≤0.8 cm2. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The American Journal of Cardiology Elsevier

Resolving Apparent Inconsistencies Between Area, Flow, and Gradient Measurements in Patients With Aortic Valve Stenosis and Preserved Left Ventricular Ejection Fraction

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Publisher
Elsevier
Copyright
Copyright © 2017 Elsevier Inc.
ISSN
0002-9149
D.O.I.
10.1016/j.amjcard.2017.11.047
Publisher site
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Abstract

Inconsistencies between area (aortic valve area [AVA])-flow-gradient are common during the echocardiographic assessment of aortic stenosis (AS). This study was conducted to investigate the importance of these inconsistencies and the impact of 3 methods to resolve these inconsistencies. The study population consisted of 327 patients (age: 76.3 ± 8.6 years, 49.5% males) with severe AS (SAS) (AVA ≤ 1 cm2) and preserved left ventricular ejection fraction (≥50%). Inconsistent findings between AVA, flow, and mean gradient (MG) were observed in 78 (23.9%) patients with low flow and a high MG, 52 (15.9%) patients with normal flow and a low MG, and 37 (11.3%) patients with a low flow and a low MG. Using stroke volume index by catheterization for AVA recalculation showed the greatest effect to resolve inconsistencies in the low flow and a high MG group (85%). Decreasing the AVA cut-off values for SAS to ≤0.8 cm2 resulted in a shift from SAS to moderate AS in 36 patients (69%) in the normal flow and a low MG. Indexing AVA to body surface area had only a minor impact on reclassification. In conclusion, in patients with SAS and preserved left ventricular ejection fraction, the majority of area-flow-gradient inconsistencies at echocardiography can be resolved by correcting errors in stroke volume index measurements by alternative techniques and by redefining the cut-off value for SAS to ≤0.8 cm2.

Journal

The American Journal of CardiologyElsevier

Published: Mar 15, 2018

References

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