The Complex Nature of Discordant Severe Calcified Aortic Valve Disease Grading
| Autor: | Joseph Malouf, Maurice Enriquez-Sarano, Marie-Annick Clavel, Caroline Cueff, Phillip A. Araoz, Alec Vahanian, Shivani R. Aggarwal, David Messika-Zeitoun, Philippe Pibarot, Romain Capoulade, Hector I. Michelena, Eric Larose |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
Ejection fraction Receiver operating characteristic medicine.diagnostic_test business.industry Stroke volume Doppler echocardiography medicine.disease Stenosis Internal medicine Concomitant Aortic valve stenosis cardiovascular system medicine Cardiology Radiology Aortic valve calcification business Cardiology and Cardiovascular Medicine |
| Zdroj: | Journal of the American College of Cardiology. 62(24):2329-2338 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2013.08.1621 |
| Popis: | Objectives With concomitant Doppler echocardiography and multidetector computed tomography (MDCT) measuring aortic valve calcification (AVC) load, this study aimed at defining: 1) independent physiologic/structural determinants of aortic valve area (AVA)/mean gradient (MG) relationship; 2) AVC thresholds best associated with severe aortic stenosis (AS); and 3) whether, in AS with discordant MG, severe calcified aortic valve disease is generally detected. Background Aortic stenosis with discordant markers of severity, AVA in severe range but low MG, is a conundrum, unresolved by outcome studies. Methods Patients (n = 646) with normal left ventricular ejection fraction AS underwent Doppler echocardiography and AVC measurement by MDCT. On the basis of AVA-indexed-to-body surface area (AVAi) and MG, patients were categorized as concordant severity grading (CG) with moderate AS (AVAi >0.6 cm²/m², MG 2 /m 2 , MG 0.6 cm 2 /m 2 , MG ≥40 mm Hg). Results The MG (discordant in 29%) was strongly determined by AVA and flow but also independently and strongly influenced by AVC-load (p 35 ml/m 2 ). The AVC-load, absolute or indexed, identified severe AS accurately (area under the curve ≥0.89, sensitivity ≥86%, specificity ≥79%) in men and women. Upon application of these criteria to DG-low MG, at least one-half of the patients were identified as severe calcified aortic valve disease, irrespective of flow. Conclusions Among patients with AS, MG is often discordant from AVA and is determined by multiple factors, valvular (AVC) and non-valvular (arterial compliance) independently of flow. The AVC-load by MDCT, strongly associated with AS severity, allows diagnosis of severe calcified aortic valve disease. At least one-half of the patients with discordant low gradient present with heavy AVC-load reflective of severe calcified aortic valve disease, emphasizing the clinical yield of AVC quantification by MDCT to diagnose and manage these complex patients. |
| Databáze: | OpenAIRE |
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