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- Lauten, Juliane, et al.
(författare)
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Invasive Hemodynamic Characteristics of Low Gradient Severe Aortic Stenosis Despite Preserved Ejection Fraction
- 2013
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Ingår i: Journal of the American College of Cardiology. - : Elsevier BV. - 0735-1097 .- 1558-3597. ; 61:17, s. 1799-1808
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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- Rost, Christian, et al.
(författare)
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Relation of Functional Echocardiographic Parameters to Infarct Scar Transmurality by Magnetic Resonance Imaging
- 2014
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Ingår i: Journal of the American Society of Echocardiography. - : Elsevier BV. - 0894-7317 .- 1097-6795. ; 27:7, s. 767-774
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Tidskriftsartikel (refereegranskat)abstract
- Background: Identification of viable but dysfunctional myocardium after myocardial infarction is important for management, including the decision for revascularization. Assessment of infarct transmurality (TRM) by late contrast enhancement on magnetic resonance imaging (MRI) is frequently used for this task but has several limitations, particularly its availability. The goal of this study was to compare the value of several simple echocardiographic parameters measured at rest at the bedside for the identification of three degrees of infarct TRM, with contrast-enhanced MRI as the gold standard. Methods: In a prospective, single-center study, 41 patients (33 men; mean age, 62 +/- 10 years; 32 with ST-segment elevation infarctions) underwent resting echocardiography and contrast-enhanced MRI < 5 days after infarction. Wall motion score, preejection velocity by tissue Doppler, and longitudinal, circumferential, and radial peak systolic strain by speckle-tracking-based strain imaging were assessed, and the findings were compared with infarct TRM stratified by contrast-enhanced MRI (no scar, 0% TRM; nontransmural scar, 1%-50% TRM; and transmural scar, 51%-100% TRM). Results: Four hundred segments showed no scar, 125 showed nontransmural scar, and 213 showed transmural scar on contrast-enhanced MRI. The sensitivity and specificity of visual wall motion scoring to detect any scar versus no scar were 71% and 81%, respectively, similar to values for circumferential strain (sensitivity and specificity both 81% with a cutoff of -14.5%). Longitudinal and radial strain performed less well, and the presence of preejection velocity performed distinctly worse (45% and 90%, respectively). The sensitivity and specificity for identifying nontransmural versus transmural infarction was better for circumferential strain (78% and 75%, respectively, with a cutoff of -10.5%) than for the other strain types, preejection velocity (52% and 67%, respectively), or visual wall motion scoring (50% and 81%, respectively, for a score > 2). Conclusion: Visual wall motion analysis alone is able to detect infarcted myocardium but cannot differentiate sufficiently between transmural and nontransmural infarction. This is best achieved at the bedside using speckle-tracking-based circumferential strain.
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