Arq. Bras. Cardiol. 2018; 110(2): 109-110
Low-Flow Low-Gradient and Low-Ejection Fraction Aortic Stenosis and Projected Aortic Valve Area Calculation: So Important but so Complicated. Let us Just Keep it Simple!
DOI: 10.5935/abc.20180030
This Short Editorial is referred by the Research article "An Alternative Method to Calculate Simplified Projected Aortic Valve Area at Normal Flow Rate".
Low-flow low-gradient aortic stenosis with low ejection fraction is still one of the main challenges not only for echocardiography but to cardiology itself. It is the very late stage of aortic stenosis that portends very poor prognosis with medical treatment, in addition to a very high operative mortality. In subjects with that condition, dobutamine stress echocardiography is of paramount importance to stratify aortic stenosis status (real aortic stenosis vs pseudo aortic stenosis) and to predict surgical mortality by the evaluation of the left ventricular contractile reserve status.–
To better differentiate both parameters, the sole use of the variation of the absolute values of aortic valve area and flow through the outflow tract carries major problems due to load conditions, previous use of medication, such as betablockers, and submaximal stress. All of these limitations may impede the detection of maximal cardiac output, a marker of contractile reserve and, therefore, may underestimate the aortic valve area.
[…]
1,356
