uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Invasive Hemodynamic Characteristics of Low Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction
Show others and affiliations
2013 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 61, no 17, 1799-1808 p.Article in journal (Refereed) Published
Abstract [en]

Objectives The study sought to compare echocardiographic with invasive hemodynamic data in patients with "paradoxic" aortic stenosis and in patients with conventionally defined severe aortic stenosis. Background Controversy exists whether low gradient severe aortic stenosis despite preserved ejection fraction ("paradoxic" aortic stenosis; aortic valve area <1 cm(2), mean gradient <40 mm Hg, ejection fraction >50%), which has been mainly diagnosed by echocardiography (echo), may be largely due to mistakes in echocardiographic measurements. Methods We compared echocardiographic and invasive hemodynamic data from 58 patients (43% male, mean age 77 +/- 5 years) with "paradoxic" aortic stenosis. Data of 22 patients (45% male, mean age 73 +/- 7 years) with conventionally defined severe aortic stenosis area (aortic valve area <= 1 cm(2), mean gradient >40 mm Hg, ejection fraction >= 50%) were also analyzed. Results In patients with "paradoxic" aortic stenosis, orifice area by echo (0.80 +/- 0.15 cm(2)) and catheterization showed modest agreement, whether stroke volume was measured by oxymetry (0.69 +/- 0.16 cm(2), bias 0.14 +/- 0.17 cm(2)), or by thermodilution (0.85 +/- 0.19 cm(2), bias -0.03 +/- 0.19 cm(2)). Mean systolic gradients were very similar (32 +/- 7 mm Hg vs. 31 +/- 6 mm Hg; bias -0.08 +/- 7.8 mm Hg). In comparison, in patients with conventionally defined severe aortic stenosis, orifice area by echo was 0.72 +/- 0.17 cm(2) and by catheterization 0.51 +/- 0.15 cm(2) (oxymetry) and 0.68 +/- 0.21 cm(2) (thermodilution), respectively, and mean systolic gradient 51 +/- 10 mm Hg and 55 +/- 8 mm Hg, respectively. Ejection fractions did not differ significantly in both groups. Ascending aortic diameter was significantly smaller in the "paradoxic" aortic stenosis group than in patients with conventionally defined severe aortic stenosis (28 +/- 5 mm vs. 31 +/- 5 mm), and energy loss index was significantly larger (0.51 +/- 0.12 cm(2)/m(2) vs. 0.42 +/- 0.09 cm(2)/m(2), respectively). Heart rate and mean blood pressure during echo and catheterization were not significantly different. Conclusions Occurrence of low gradient severe aortic stenosis despite preserved ejection fraction was confirmed by invasive hemodynamics and was not the result of a systematic bias in the echo calculation of aortic orifice area. 

Place, publisher, year, edition, pages
2013. Vol. 61, no 17, 1799-1808 p.
Keyword [en]
aortic stenosis, cardiac catherization, echocardiography
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:uu:diva-200058DOI: 10.1016/j.jacc.2013.02.009ISI: 000317842200008PubMedID: 23500295OAI: oai:DiVA.org:uu-200058DiVA: diva2:622907
Available from: 2013-05-23 Created: 2013-05-20 Last updated: 2017-12-06Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed

Authority records BETA

Flachskampf, Frank A.

Search in DiVA

By author/editor
Flachskampf, Frank A.
By organisation
Cardiology
In the same journal
Journal of the American College of Cardiology
Cardiac and Cardiovascular Systems

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 379 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf