A Better Way to Predict Outcome in Low-Flow Aortic Stenosis

Calculating the projected aortic valve area may be better than the usual dobutamine stress echocardiographic criteria for identifying severe AS.

Distinguishing between true severe aortic stenosis (AS) and pseudo-severe AS in patients with low gradient, low left ventricular ejection fraction (LVEF), and calculated low aortic valve area (AVA) is difficult. Current guidelines suggest assessment with dobutamine stress echocardiography (DSE). These investigators compared DSE using the usual criteria for severe AS (at peak dobutamine dose: mean gradient, ≥40 mm Hg; AVA ≤1 cm²) with DSE measuring the projected AVA at normal transvalvular flow (250 mL/minute) in 186 patients (mean gradient, <40 mm Hg; indexed AVA, ≤0.6 cm²/m²; LVEF, ≤40).

Severity of AS was assessed in 87 patients by computed tomography calcium score or by direct examination during surgery. In this subgroup, the sensitivity …

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)