Abstract
PurposeIn echocardiography the severity of aortic stenosis (AS) is defined by effective orifice area (EOA), mean pressure gradient (mPGAV) and transvalvular flow velocity (maxVAV). The hypothesis of the present study was to confirm the pathophysiological presence of combined left ventricular hypertrophy (LVH), diastolic dysfunction (DD) and pulmonary artery hypertension (PAH) in patients with “pure” severe AS.Methods and ResultsPatients (n = 306) with asymptomatic (n = 133) and symptomatic (n = 173) “pure” severe AS (mean age 78 ± 9.5 years) defined by indexed EOA < 0.6 cm2 were enrolled between 2014 and 2016. AS patients were divided into 4 subgroups according to mPGAV and indexed left ventricular stroke volume: low flow (LF) low gradient (LG)-AS (n = 133), normal flow (NF) LG-AS (n = 91), LF high gradient (HG)-AS (n = 21) and NFHG-AS (n = 61). Patients with “pure” severe AS showed mean mPGAV of 31.7 ± 9.1 mmHg and mean maxVAV of 3.8 ± 0.6 m/s. Only 131 of 306 patients (43%) exhibited mPGAV > 40 mmHg and maxVAV > 4 m/s documenting incongruencies of the AS severity assessment by Doppler echocardiography. LVH was documented in 81%, DD in 76% and PAH in 80% of AS patients. 54% of “pure” AS patients exhibited all three alterations. Ranges of mPGAV and maxVAV were higher in patients with all three alterations compared to patients with less than three. 224 (73%) patients presented LG-conditions and 82 (27%) HG-conditions. LVH was predominant in NF-AS (p = 0.014) and PAH in LFHG-AS (p = 0.014). Patients’ treatment was retrospectively assessed (surgery: n = 100, TAVI: n = 48, optimal medical treatment: n = 156).ConclusionIn patients with “pure” AS according to current guidelines the presence of combined LVH, DD and PAH as accepted pathophysiological sequelae of severe AS cannot be confirmed. Probably, the detection of these secondary cardiac alterations might improve the diagnostic algorithm to avoid overestimation of AS severity.
Highlights
Aortic valve stenosis (AS) due to degenerative calcifications is the most common valvular heart disease [1]
Denmark transvalvular flow velocity (maxVAV), mean transvalvular pressure gradient (mPGAV) and effective aortic orifice area (EOA) calculated by the continuity equation are recommended as the primary key parameters to evaluate AS severity
The echocardiographic characterization of “pure” severe AS based on effective orifice area (EOA) by the continuity equation might implicate diagnostic incongruencies
Summary
Aortic valve stenosis (AS) due to degenerative calcifications is the most common valvular heart disease [1]. The International Journal of Cardiovascular Imaging (2020) 36:1917–1929 ventricular hypertrophy (LVH), diastolic dysfunction (DD) and pulmonary artery hypertension (PAH) are generally assumed in patients with severe AS. Severe AS induces an increase of LV pressure followed by the development of concentric LVH. Concentric LVH leads to a higher diastolic pressure–volume relationship resulting in an increased LV end-diastolic pressure (LVEDP) as evidence of DD. LVH, DD and PAH can be induced by other diseases independently of AS. According to these circumstances it might be possible that either the pathophysiological sequelae of AS are not fully understood or that patients with hemodynamically not relevant AS will be characterized as severe AS according to current guideline criteria [19]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
