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Proof of concept study on coronary microvascular function in low flow low gradient aortic stenosis
Conclusions CMD is more severe in patients with LFLGAS compared with NFHGAS and is associated with low-flow state, left atrial dysfunction and reduced cardiac performance.
Source: Heart - April 25, 2023 Category: Cardiology Authors: Scarsini, R., Pighi, M., Mainardi, A., Portolan, L., Springhetti, P., Mammone, C., Della Mora, F., Fanti, D., Tavella, D., Gottin, L., Bergamini, C., Benfari, G., Pesarini, G., Ribichini, F. L. Tags: Valvular heart disease Source Type: research

Early surgical intervention versus conservative management of asymptomatic severe aortic stenosis: a systematic review and meta-analysis
Conclusions This study suggests that for patients with asymptomatic severe AS an early surgical intervention compared with a conservative WW strategy was associated with a lower heart failure hospitalisation and a similar rate of stroke or myocardial infarction, although with significant risk of bias. PROSPERO registration number CRD42021291144.
Source: Heart - January 27, 2023 Category: Cardiology Authors: Costa, G. N. F., Cardoso, J. F. L., Oliveiros, B., Goncalves, L., Teixeira, R. Tags: Valvular heart disease Source Type: research

Inter-racial differences in patients undergoing transcatheter aortic valve implantation
Conclusions There were significant differences in baseline and procedural factors among Asian and non-Asian patients who underwent TAVI. Observed inter-racial differences in clinical outcomes were largely explained by baseline differences in clinical, anatomical and procedural factors. Trial registration number NCT03826264 (https://wwwclinicaltrialsgov).
Source: Heart - September 12, 2022 Category: Cardiology Authors: Kang, D.-Y., Ahn, J.-M., Kim, J. B., Yeung, A., Nishi, T., Fearon, W., Cantey, E. P., Flaherty, J. D., Davidson, C. J., Malaisrie, S. C., Park, S. Y., Yun, S.-C., Ko, E., Park, H., Lee, S.-A., Kim, D.-H., Kim, H. J., Kim, J. B., Choo, S. J., Park, D.-W., Tags: Valvular heart disease Source Type: research

Cardiovascular highlights from non-cardiology journals
Transcatheter aortic valve implantation in intermediate risk patients Transcatheter aortic valve implantation (TAVI) has had a major impact on both morbidity and mortality in high-risk and inoperable patients with severe aortic stenosis. Robust evidence has supported widespread adoption in this patient group but uncertainty exists as to whether TAVI may also achieve clinical equipoise with surgical aortic valve replacement (AVR) in lower risk groups. In the industry sponsored PARTNER 2 trial, patients deemed at intermediate surgical risk (generally with an STS score between 4 and 8) were randomized to either TAVI with the ...
Source: Heart - July 25, 2016 Category: Cardiology Authors: McCabe, J. M. Tags: Journal scan Source Type: research

Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban
Conclusions We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD. Trial registration number NCT00403767; Post-results.
Source: Heart - June 9, 2016 Category: Cardiology Authors: Breithardt, G., Baumgartner, H., Berkowitz, S. D., Hellkamp, A. S., Piccini, J. P., Lokhnygina, Y., Halperin, J. L., Singer, D. E., Hankey, G. J., Hacke, W., Becker, R. C., Nessel, C. C., Mahaffey, K. W., Califf, R. M., Fox, K. A. A., Patel, M. R., for th Tags: Open access, Drugs: cardiovascular system, Interventional cardiology, Aortic valve disease, Mitral valve disease Valvular heart disease Source Type: research

Heartbeat: Go with the flow in aortic stenosis?
Aortic valve stenosis (AS), at the simplest level, is mechanical obstruction to left ventricular (LV) outflow with severity best described by the high velocity or pressure gradient across the valve or the small valve opening area. More recently, the importance of adverse left ventricular (LV) changes in patients with aortic valve disease has led to a new classification of AS to include measures of LV function and volume flow rate as follows: (1) high gradient severe AS with a transvalvular velocity ≥4 m/s or mean gradient ≥40 mm Hg, (2) low-flow low-gradient severe AS with reduced ejection fraction (<50%), an...
Source: Heart - June 5, 2016 Category: Cardiology Authors: Otto, C. M. Tags: Drugs: cardiovascular system, Echocardiography, Aortic valve disease, Clinical diagnostic tests, Epidemiology Heartbeat Source Type: research

Echocardiographic predictors of outcomes in adults with aortic stenosis
Conclusions The most powerful echocardiographic predictors of mortality are low LVEF and low flow, whereas AS severity parameters predict valve-related events but not overall mortality. Hence, low flow should be integrated in the risk stratification and therapeutic decision-making in patients with AS.
Source: Heart - June 5, 2016 Category: Cardiology Authors: Capoulade, R., Le Ven, F., Clavel, M.-A., Dumesnil, J. G., Dahou, A., Thebault, C., Arsenault, M., O'Connor, K., Bedard, E., Beaudoin, J., Senechal, M., Bernier, M., Pibarot, P. Tags: Editor's choice, Drugs: cardiovascular system, Echocardiography, Aortic valve disease, Clinical diagnostic tests, Epidemiology Valvular heart disease Source Type: research

The spectrum of low-output low-gradient aortic stenosis with normal ejection fraction
Low-flow, low-gradient (LF/LG) severe aortic stenosis (AS) with preserved ejection fraction refers to the condition of AS with aortic valve area ≤1 cm2, stroke volume index <35 mL/m2, mean aortic valve gradient <40 mm Hg and left ventricular ejection fraction ≥50%. This mismatch of aortic valve area suggesting severe stenosis and ‘low’ gradient in some patients has led to confusion as to the severity of stenosis. Conditions previously labelled as LF/LG severe AS include a spectrum, with measurement error probably being the most common cause of marked inconsistency between gradien...
Source: Heart - April 11, 2016 Category: Cardiology Authors: Pislaru, S. V., Pellikka, P. A. Tags: Review articles Reviews Source Type: research

Watchful observation versus early aortic valve replacement for symptomatic patients with normal flow, low-gradient severe aortic stenosis
Conclusions Early AVR and watchful observation strategy show similar survival in symptomatic patients with normal flow, low-gradient severe AS and preserved LVEF. Watchful observation with timely performance of AVR should be considered a therapeutic option.
Source: Heart - August 12, 2015 Category: Cardiology Authors: Kang, D.-H., Jang, J. Y., Park, S.-J., Kim, D.-H., Yun, S.-C., Song, J.-M., Park, S. W., Chung, C.-H., Song, J.-K., Lee, J.-W. Tags: Drugs: cardiovascular system, Aortic valve disease, Epidemiology Valvular heart disease Source Type: research

Paradoxical low-flow, low-gradient severe aortic stenosis: a distinct disease entity
Low-flow, low-gradient (LFLG) severe aortic stenosis (AS), despite preserved LVEF, that is, paradoxical LFLG, is one of the most challenging entities in valvular heart disease.1 Hachicha et al were the first to report that patients with small aortic valve area (AVA) and preserved LVEF may concomitantly have an LF and thus often low gradient.1 This new entity is defined as an AVA ≤1.0 cm2 or indexed AVA ≤0.6 cm2/m2, a mean pressure gradient (MPG) <40 mm Hg, an LVEF ≥50% and a stroke volume index (SVi) <35 mL/m2. The most recent European2 and American3 guidelines have recognised parado...
Source: Heart - June 10, 2015 Category: Cardiology Authors: Magne, J., Mohty, D. Tags: Drugs: cardiovascular system, Echocardiography, Aortic valve disease, Right sided valvular heart disease, Clinical diagnostic tests Editorials Source Type: research

Development of paradoxical low-flow, low-gradient severe aortic stenosis
Conclusions LFLG-sAS is a distinct presentation of sAS preceded by a unique remodelling pathway and is uncommonly preceded by an HG stage.
Source: Heart - June 10, 2015 Category: Cardiology Authors: Dahl, J. S., Eleid, M. F., Pislaru, S. V., Scott, C. G., Connolly, H. M., Pellikka, P. A. Tags: Drugs: cardiovascular system, Echocardiography, Aortic valve disease, Clinical diagnostic tests Valvular heart disease Source Type: research

Cardiovascular highlights from non-cardiology journals
Long-Term Outcomes of Transcatheter Aortic Valve Replacement The Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated that transcatheter aortic valve replacement (TAVR) for high-risk patients with aortic stenosis resulted in similar outcomes at 1, 2 and 3 years compared with surgical aortic valve replacement (SAVR). The present study reports the 5-year outcomes of this trial. The study enrolled 699 patients who were randomized to SAVR or TAVR (via a transfemoral or transapical approach). Overall, mean age was 84.1 years, 94% were NYHA Class 3 or 4, and the mean Society of Thoracic Surgeons Predicted Risk o...
Source: Heart - May 25, 2015 Category: Cardiology Authors: Bradley, S. M. Tags: Journal scan Source Type: research

Prognosis importance of low flow in aortic stenosis with preserved LVEF
Conclusions In patients with severe AS and preserved LVEF, LF, as assessed using cardiac catheterisation is frequent, and is an independent predictor of mortality. Consequently, the measurement of SVi should be systematically included in the assessment of these patients.
Source: Heart - April 24, 2015 Category: Cardiology Authors: Magne, J., Mohty, D., Boulogne, C., Boubadara, F. E., Deltreuil, M., Echahidi, N., Cassat, C., Laskar, M., Virot, P., Aboyans, V. Tags: Drugs: cardiovascular system, Echocardiography, Aortic valve disease, Clinical diagnostic tests, Epidemiology Valvular heart disease Source Type: research

Sex differences in cardiovascular outcome during progression of aortic valve stenosis
Conclusions In the SEAS study, women and men had similar rates of AS progression and AS-related events. However, women had lower total mortality and ischaemic CV event rate than men independent of confounders. Trial registration number ClinicalTrials.gov identifier: NCT00092677.
Source: Heart - January 14, 2015 Category: Cardiology Authors: Cramariuc, D., Rogge, B. P., Lonnebakken, M. T., Boman, K., Bahlmann, E., Gohlke-Barwolf, C., Chambers, J. B., Pedersen, T. R., Gerdts, E. Tags: Open access, Drugs: cardiovascular system, Echocardiography, Hypertension, Interventional cardiology, Aortic valve disease, Clinical diagnostic tests, Epidemiology Valvular heart disease Source Type: research

Aortic stenosis: flow matters
The presence of a low transvalvular pressure gradient (<40 mm Hg) in conjunction with a small aortic valve area (AVA ≤1 cm2) is a challenging situation as it raises uncertainty about the actual severity of aortic stenosis (AS) and therefore about the indication of aortic valve replacement (AVR) if the patient is symptomatic. This low-gradient ‘severe’ (small AVA) AS entity may in fact be related to: (i) measurement errors: underestimation of stroke volume (SV), AVA and/or gradient;S1 (ii) small body size: a small AVA in a small patient may correspond to moderate AS and low gradient; (iii) i...
Source: Heart - December 12, 2014 Category: Cardiology Authors: Pibarot, P. Tags: Drugs: cardiovascular system, Echocardiography, Hypertension, Aortic valve disease, Mitral valve disease, Right sided valvular heart disease, Clinical diagnostic tests, Epidemiology Editorials Source Type: research

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