Diagnosis and management of low-flow, low-gradient aortic stenosis

This article summarizes current guidelines and best practices for the management of low-flow, low-gradient aortic stenosis. Summary Low-flow, low-gradient aortic stenosis is a difficult entity to diagnose and treat. Various diagnostic modalities are needed to accurately determine the severity of aortic stenosis and potential treatment benefit. True-severe classical and paradoxical low-flow, low-gradient aortic stenosis can be distinguished from pseudo-severe aortic stenosis by dobutamine stress echocardiography and/or multidetector computed tomography. Once the distinction is made, aortic valve replacement results in better outcomes compared with conservative management. Although both surgical and transcatheter aortic valve replacement result in adequate outcomes, the decision between the two treatment strategies is based on patient characteristics, valve morphology, and other risk factors.
Source: Current Opinion in Cardiology - Category: Cardiology Tags: VALVULAR HEART DISEASE: Edited by Subodh Verma and Bobby Yanagawa Source Type: research

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AbstractPurpose of ReviewAortic stenosis is the most prevalent valvular heart disease. The purpose of this paper is to review the epidemiology, pathophysiology, and diagnosis of aortic valve stenosis.Recent FindingsThe diagnosis of aortic stenosis has evolved over time. Originally diagnosed with cardiac catheterization and echocardiography, more advance imaging techniques including computed tomography, magnetic resonance imaging, and 3D printing have improved our understanding of the physiology and hemodynamic effects of aortic stenosis.SummaryValvular heart disease affects a broad patient population, and the most common f...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research
Conclusion: Preprocedural evaluation is one of the most important steps in TAVR. Computed tomography imaging provides extensive information, not only for procedure planning. Our findings emphasize that computed tomography has a crucial role for the preprocedural evaluation of TAVR candidates. PMID: 31061731 [PubMed]
Source: Cardiology Research and Practice - Category: Cardiology Authors: Tags: Cardiol Res Pract Source Type: research
Calcific aortic stenosis (AS) is the most common valvular heart disease in developed countries,1 characterized by progressive fibrocalcific changes within the valve leaflets leading to eventual outflow tract obstruction. Severe symptomatic stenosis is an indication for aortic valve replacement, and timely referral is essential to prevent adverse clinical events. The evaluation of AS severity is routinely performed using echocardiography and commonly graded using the peak aortic jet velocity, mean gradient, and aortic valve area.
Source: Journal of Cardiovascular Computed Tomography - Category: Radiology Authors: Source Type: research
This study aimed to assess characteristics and computed tomography (CT) findings of the aortic valve in old patients with RHD and to investigate the safety and efficacy in the patients who underwent TAVR.
Source: International Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Background— Computed tomography aortic valve calcium scoring (CT-AVC) holds promise for the assessment of patients with aortic stenosis (AS). We sought to establish the clinical utility of CT-AVC in an international multicenter cohort of patients. Methods and Results— Patients with AS who underwent ECG-gated CT-AVC within 3 months of echocardiography were entered into an international, multicenter, observational registry. Optimal CT-AVC thresholds for diagnosing severe AS were determined in patients with concordant echocardiographic assessments, before being used to arbitrate disease severity in those with dis...
Source: Circulation: Cardiovascular Imaging - Category: Radiology Authors: Tags: Valvular Heart Disease, Computerized Tomography (CT), Echocardiography Source Type: research
Opinion statementIn the United States, valvular heart disease (VHD) has a prevalence of 2.5%, most commonly presenting as aortic stenosis (AS) or mitral valve regurgitation (MR) and increasingly observed to be of a degenerative etiology. Women frequently have latent symptoms despite significant disease, and it is therefore pertinent to consider both clinical symptoms and imaging findings for decision-making on treatment. Indeed, significant advances have been made in noninvasive imaging allowing for more accurate diagnosis and disease prognostication. While echo remains the standard diagnostic test, multidetector computed ...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
Background— In patients with bicuspid aortic valve and dilated proximal ascending aorta, we sought to assess (1) factors associated with increased longer-term cardiovascular mortality and (2) incremental prognostic use of indexing aortic root to patient height. Methods and Results— We studied 969 consecutive bicuspid aortic valve patients (50±13 years; 87% men) with proximal aorta ≥4 cm, who also had a gated contrast-enhanced thoracic computed tomography or magnetic resonance angiography. A ratio of ascending aortic area/height was calculated on tomography, and ≥10 cm2/m was considered abnormal, a...
Source: Circulation: Cardiovascular Imaging - Category: Radiology Authors: Tags: Computerized Tomography (CT), Echocardiography, Magnetic Resonance Imaging (MRI), Aneurysm Valvular Heart Disease Source Type: research
Conclusions— Preoperative MDCT measurements differ substantially from direct intraoperative assessment of the aortic annulus. Implanted surgical aortic valve replacement valves were smaller relative to MDCT-based sizing in 41% of patients, and the potential GOA was between 25% and 40.6% larger if patients had undergone transcatheter aortic valve replacement.
Source: Circulation: Cardiovascular Imaging - Category: Radiology Authors: Tags: Computerized Tomography (CT), Imaging, Aortic Valve Replacement/Transcatheter Aortic Valve Implantation, Catheter-Based Coronary and Valvular Interventions Valvular Heart Disease Source Type: research
Aortic stenosis (AS) is the most frequently observed valvular heart disease. During the symptomatic stage, the rate of death increases dramatically, so that a precise diagnostic approach is taken to guide therapeutic options. Of patients with severe AS, 30% to 50% present with low‐flow/low‐gradient AS (LF/LGAS) status. This review focuses on LF/LGAS and the best diagnostic and therapeutic management in either classic LF/LGAS with reduced left ventricular ejection fraction (LVEF) or paradoxical LF/LGAS with preserved LVEF. Current literature demonstrates that in classic LF/LGAS it is crucial to rule out a pseudo‐sever...
Source: Clinical Cardiology - Category: Cardiology Authors: Tags: Review Source Type: research
Authors: Truong VT, Choo J, McCoy L, Mussman A, Ambach S, Kereiakes D, Sarembock I, Mazur W Abstract OBJECTIVES: To investigate the feasibility and image quality of low-dose contrast computed tomography (CT) angiography with pulmonary artery (PA) protocol. BACKGROUND: Aortic stenosis is the most common valvular heart disease and transcatheter aortic valve replacement (TAVR) has evolved as an alternative method for surgical valve replacement in intermediate-risk and high-risk surgical patients. CT is essential for measurement of aortic annulus prior to TAVR. METHODS: Twenty patients underwent a low-dose cont...
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
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