|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
|
|
|
|||||||||
|
|||||||||||
|
J Am Coll Cardiol, 2003; 41:142-151 © 2003 by the American College of Cardiology Foundation |
* Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Manuscript received March 3, 2000; revised manuscript received April 29, 2002, accepted August 30, 2002.
* Reprint requests and correspondence: Dr. Javier Bermejo, Laboratory of Echocardiography, Department of Cardiology, Hospital General Universitario Gregorio Marañón, Dr. Esquerdo 46. 28007 Madrid, Spain.
javbermejo{at}jet.es
OBJECTIVES: This study was designed to assess which hemodynamic index best accounts for clinical severity of aortic stenosis (AS) and to analyze the value of low-dose dobutamine testing.
BACKGROUND: Pressure gradient and valve area are suboptimal because they depend on flow rate, correlate poorly with symptoms, and provide limited prognostic information. Recently, new indices and low-dose inotropic stimulation have been introduced, but their clinical value remains uncertain.
METHODS: A total of 307 consecutive patients with AS were included in an ambispective study design (71 ± 12 years old; peak jet velocity: 3.7 ± 1.1 m/s). Clinical and Doppler-echocardiographic data were obtained, as well as results of low-dose dobutamine infusion (47 patients). Using receiver-operator-characteristic curve analysis, we evaluated jet velocity, pressure gradient, valve area, resistance, stroke-work loss (SWL), and dobutamine-induced increase in area for predicting 1) symptomatic status at entry, 2) early (
3 months) cardiovascular death or aortic valve replacement, and 3) long-term outcome. Logistic regression and Cox models were designed multivariate and adjusted by bootstrapping.
RESULTS: Only 28% of patients were alive without valve replacement at the end of the follow-up period (22 ± 4 months). The decision for valve replacement was made by the referring physician, blinded to the SWL, valve resistance, and dobutamine results. Non–flow-corrected indices performed better than valve area and valve resistance. Among them, SWL best predicted the defined end points. Odds/hazard ratios associated with a SWL 
= 17% were 5.14 for presenting AS symptoms, 4.68 for early events, and 2.31 for late outcome. A cutoff value of SWL >25% best discriminated clinical end points. Other independent predictors of prognosis were symptomatic status and left ventricular ejection fraction. Dobutamine testing added no value to baseline models.
CONCLUSIONS: Non–flow-corrected indices show the highest clinical efficacy in aortic stenosis. Among these, SWL best predicts symptomatic status and outcome and therefore should be incorporated to aid patient management in unclear situations.
| ||||||||||||||||||||||||
This article has been cited by other articles:
|
|
 |
|
  K. Wachtell Left ventricular systolic performance in asymptomatic aortic stenosis Eur. Heart J. Suppl., July 1, 2008; 10(suppl_E): E16 - E22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Turto, J. Lommi, M. Ventila, and M. Kupari Doppler echocardiography markedly underestimates left ventricular stroke work loss in severe aortic valve stenosis Eur J Echocardiogr, October 1, 2007; 8(5): 341 - 345. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. H Little, K.-L. Chan, and I. G Burwash Impact of blood pressure on the Doppler echocardiographic assessment of severity of aortic stenosis Heart, July 1, 2007; 93(7): 848 - 855. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Bermejo and R Yotti Low-gradient aortic valve stenosis: value and limitations of dobutamine stress testing Heart, March 1, 2007; 93(3): 298 - 302. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, A. Vahanian, H. Baumgartner, J. Bax, E. Butchart, R. Dion, G. Filippatos, F. Flachskampf, R. Hall, B. Iung, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology Eur. Heart J., January 26, 2007; (2007) ehl428v1. [Full Text] [PDF]
|
|
|
|
 |
|
 K. K. Stout and C. M. Otto Indications for Aortic Valve Replacement in Aortic Stenosis J Intensive Care Med, January 1, 2007; 22(1): 14 - 25. [Abstract] [PDF]
|
|
|
|
 |
|
 C. M. Otto Valvular Aortic Stenosis: Disease Severity and Timing of Intervention J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2141 - 2151. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Blais, I. G. Burwash, G. Mundigler, J. G. Dumesnil, N. Loho, F. Rader, H. Baumgartner, R. S. Beanlands, B. Chayer, L. Kadem, et al. Projected Valve Area at Normal Flow Rate Improves the Assessment of Stenosis Severity in Patients With Low-Flow, Low-Gradient Aortic Stenosis: The Multicenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) Study Circulation, February 7, 2006; 113(5): 711 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Jimenez-Candil, J Bermejo, R Yotti, C Cortina, M Moreno, J L Cantalapiedra, and M A Garcia-Fernandez Effects of angiotensin converting enzyme inhibitors in hypertensive patients with aortic valve stenosis: a drug withdrawal study Heart, October 1, 2005; 91(10): 1311 - 1318. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Briand, J. G. Dumesnil, L. Kadem, A. G. Tongue, R. Rieu, D. Garcia, and P. Pibarot Reduced Systemic Arterial Compliance Impacts Significantly on Left Ventricular Afterload and Function in Aortic Stenosis: Implications for Diagnosis and Treatment J. Am. Coll. Cardiol., July 19, 2005; 46(2): 291 - 298. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J Bermejo The effects of hypertension on aortic valve stenosis Heart, March 1, 2005; 91(3): 280 - 282. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. D. Bello, D. Giorgi, P. Viacava, T. Enrica, C. Nardi, C. Palagi, M. G. D. Donne, F. Verunelli, M. A. Mariani, J. Grandjean, et al. Severe Aortic Stenosis and Myocardial Function: Diagnostic and Prognostic Usefulness of Ultrasonic Integrated Backscatter Analysis Circulation, August 17, 2004; 110(7): 849 - 855. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Weerasinghe, M. Yusuf, T. Athanasiou, A. Wood, P. Magee, and R. Uppal Role of transvalvular gradient in outcome from valve replacement for aortic stenosis Ann. Thorac. Surg., April 1, 2004; 77(4): 1266 - 1271. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Weyman The year in echocardiography J. Am. Coll. Cardiol., January 7, 2004; 43(1): 140 - 148. [Full Text] [PDF]
|
|
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |
