A Novel Echocardiographic Parameter to Confirm Low-Gradient Aortic Stenosis Severity.

Autor:	Hecht S; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada., Annabi MS; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada., Stanová V; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada., Dahou A; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada., Burwash IG; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Koschutnik M; Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Bartko PE; Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Bergler-Klein J; Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Mascherbauer J; Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria., Donà C; Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Orwat S; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany., Baumgartner H; Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany., Cavalcante JL; Department of Cardiology, Minneapolis Heart Institute, Cardiology, Minneapolis, United States.; Division of Cardiology, University of Pittsburgh, Pittsburgh, United States., Ribeiro HB; Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil., Théron A; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada.; Department of Cardiac Surgery, La Timone Public Hospital, Marseille, France., Rodes-Cabau J; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada., Clavel MA; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada., Pibarot P; Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada.
Jazyk:	angličtina
Zdroj:	JACC. Advances [JACC Adv] 2024 Sep 06; Vol. 3 (10), pp. 101245. Date of Electronic Publication: 2024 Sep 06 (Print Publication: 2024).
DOI:	10.1016/j.jacadv.2024.101245
Abstrakt:	Background: In patients with low-gradient (LG) aortic stenosis (AS), confirming disease severity and indication of intervention often requires dobutamine stress echocardiography (DSE) or aortic valve calcium scoring by computed tomography. We hypothesized that the mean transvalvular pressure gradient to effective orifice area ratio (MG/EOA, in mm Hg/cm 2 ) measured during rest echocardiography identifies true-severe AS (TSAS) and is associated with clinical outcomes in patients with low-flow, LG-AS. Objectives: The purpose of this study was to evaluate the diagnostic and prognostic value of MG/EOA ratio. Methods: The diagnostic accuracy of MG/EOA ratio to identify TSAS was retrospectively assessed in: 1) an in vitro data set obtained in a circulatory model including 93 experimental conditions; and 2) an in vivo data set of 188 patients from the TOPAS (True or Pseudo-Severe Aortic Stenosis) study (NCT01835028). Receiver operating characteristic curves were used to assess the diagnostic accuracy of MG/EOA ratio for identifying TSAS, and Cox proportional hazards regression analyses were performed to assess its association with clinical outcomes. Results: The optimal cutoff of MG/EOA ratio to identify TSAS in patients with low-flow, LG-AS was ≥25 mm Hg/cm 2 (correct classification 85%), as well as in vitro (100%). During a median follow-up of 1.41 ± 0.75 years, 146 (78%) patients met the composite endpoint of aortic valve replacement or all-cause mortality. A MG/EOA ratio ≥25 mm Hg/cm 2 was independently associated with an increased risk of the composite endpoint (adjusted HR: 2.36 [95% CI: 1.63-3.42], P  < 0.001). The Harell's C-index of MG/EOA was 0.68, equaling projected EOA (0.67) measured by DSE. Conclusions: MG/EOA ratio can be useful in low-flow, LG-AS to confirm AS severity and may complement DSE or aortic valve calcium scoring. Competing Interests: This work was supported by a grant (# MOP-57445 for TOPAS-II and # MOP-126072 and FDN-143225 for TOPAS-III) from the 10.13039/501100000024Canadian Institutes of Health Research, Ottawa, Canada. Dr Dahou was supported by a fellowship grant from “L’Agence de la santé et des services sociaux de la Capitale nationale-ADLSSS”, Québec, Québec, Canada. Dr Clavel is recopied of a national new investigator award from the heart and stroke foundation of Canada and received funding from 10.13039/100006520Edwards Lifesciences for computed tomography CoreLab analyses with no personal compensation and research grant from 10.13039/100004374Medtronic. Dr Rodes-Cabau has received institutional research grants from 10.13039/100006520Edwards Lifesciences, 10.13039/100004374Medtronic, and 10.13039/100008497Boston Scientific. Dr Pibarot holds the Canada Research Chair in Valvular Heart Diseases, 10.13039/501100000024Canadian Institutes of Health Research; and has received funding from 10.13039/100006520Edwards Lifesciences and 10.13039/100004374Medtronic for echocardiography CoreLab analyses with no personal compensation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. (© 2024 The Authors.)
Databáze:	MEDLINE
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