Journal of the American Society of Echocardiography
Volume 23, Issue 4 , Pages 380-386 , April 2010

Validation of Conventional and Simplified Methods to Calculate Projected Valve Area at Normal Flow Rate in Patients With Low Flow, Low Gradient Aortic Stenosis: The Multicenter TOPAS (True or Pseudo Severe Aortic Stenosis) Study

  • Marie-Annick Clavel, DVM, MSc

      Affiliations

    • Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada
    • ,
  • Ian G. Burwash, MD

      Affiliations

    • University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    • ,
  • Gerald Mundigler, MD

      Affiliations

    • Vienna General Hospital, Medical University of Vienna, Vienna, Austria
    • ,
  • Jean G. Dumesnil, MD

      Affiliations

    • Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada
    • ,
  • Helmut Baumgartner, MD

      Affiliations

    • Munster General Hospital, Munster, Germany
    • ,
  • Jutta Bergler-Klein, MD

      Affiliations

    • Vienna General Hospital, Medical University of Vienna, Vienna, Austria
    • ,
  • Mario Sénéchal, MD

      Affiliations

    • Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada
    • ,
  • Patrick Mathieu, MD

      Affiliations

    • Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada
    • ,
  • Christian Couture, MD

      Affiliations

    • Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada
    • ,
  • Rob Beanlands, MD FRCP C

      Affiliations

    • University of Ottawa Heart Institute, Ottawa, Ontario, Canada
    • ,
  • Philippe Pibarot, DVM, PhD

      Affiliations

    • Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec, Quebec City, Canada
    • Corresponding Author InformationReprint requests: Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Quebec, QC, G1V-4G5, Canada.

References 

  1. Monin JL, Quere JP, Monchi M, Petit H, Baleynaud S, Chauvel C, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003;108:319–324
  2. Burwash IG. Low-flow, low-gradient aortic stenosis: from evaluation to treatment. Curr Opin Cardiol. 2007;22:84–91
  3. Bermejo J, Yotti R. Low-gradient aortic valve stenosis. Value and limitations of dobutamine stress testing. Heart. 2007;93:298–302
  4. Bergler-Klein J, Mundigler G, Pibarot P, Burwash IG, Dumesnil JG, Blais C, et al. B-type natriuretic peptide in low-flow, low-gradient aortic stenosis: relationship to hemodynamics and clinical outcome. Circulation. 2007;115:2848–2855
  5. Clavel MA, Fuchs C, Burwash IG, Mundigler G, Dumesnil JG, Baumgartner H, et al. Predictors of outcomes in low-flow, low-gradient aortic stenosis: results of the multicenter TOPAS study. Circulation. 2008;118(suppl):S234–S242
  6. deFilippi CR, Willett DL, Brickner E, Appleton CP, Yancy CW, Eichhorn EJ, et al. Usefulness of dobutamine echocardiography in distinguishing severe from nonsevere valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradients. Am J Cardiol. 1995;75:191–194
  7. Blais C, Pibarot P, Dumesnil JG, Garcia D, Chen D, Durand LG. Comparison of valve resistance with effective orifice area regarding flow dependence. Am J Cardiol. 2001;88:45–52
  8. Burwash IG, Hay KM, Chan KL. Hemodynamic stability of valve area, valve resistance and stroke work loss in aortic stenosis: a comparative analysis. J Am Soc Echocardiogr. 2002;15:814–822
  9. Blais C, Burwash IG, Mundigler G, Dumesnil JG, Loho N, Rader F, et al. The projected valve area at normal flow rate improves the assessment of stenosis severity in patients with low flow aortic stenosis: the multicenter TOPAS (Truly or Pseudo Severe Aortic Stenosis) study. Circulation. 2006;113:711–721
  10. Roberts WC, Ko JM, Hamilton C. Comparison of valve structure, valve weight, and severity of the valve obstruction in 1849 patients having isolated aortic valve replacement for aortic valve stenosis (with or without associated aortic regurgitation) studied at 3 different medical centers in 2 different time periods. Circulation. 2005;112:3919–3929
  11. Connolly HM, Oh JK, Schaff HV, Roger VL, Osborn SL, et al. Severe aortic stenosis with low transvalvular gradient and severe left ventricular dysfunction. Result of aortic valve replacement in 52 patients. Circulation. 2000;101:1940–1946
  12. Levy F, Laurent M, Monin JL, Maillet JM, Pasquet A, Le Tourneau T, et al. Aortic valve replacement for low-flow/low-gradient aortic stenosis: operative risk stratification and long-term outcome: a European multicenter study. J Am Coll Cardiol. 2008;51:1466–1472
  13. Nishimura RA, Grantham JA, Connolly HM, Schaff HV, Higano ST, Holmes DR. Low-output, low-gradient aortic stenosis in patients with depressed left ventricular systolic function: the clinical utility of the dobutamine challenge in the catheterization laboratory. Circulation. 2002;106:809–813
  14. Blais C, Dumesnil JG, Baillot R, Simard S, Doyle D, Pibarot P. Impact of prosthesis-patient mismatch on short-term mortality after aortic valve replacement. Circulation. 2003;108:983–988
  15. Pibarot P, Dumesnil JG. Prosthetic heart valves: Selection of the optimal prosthesis and long-term management. Circulation. 2009;119:1034–1048
  16. Clavel MA, Webb JG, Pibarot P, Altwegg L, Dumont E, Thompson C, et al. Comparison of the hemodynamic performance of percutaneous and surgical bioprostheses for the treatment of severe aortic stenosis. J Am Coll Cardiol. 2009;53:1883–1891
  17. Das P, Rimington H, Smeeton N, Chambers J. Determinants of symptoms and exercise capacity in aortic stenosis: a comparison of resting haemodynamics and valve compliance during dobutamine stress. Eur Heart J. 2003;24:1254–1263
  18. Leye M, Brochet E, Lepage L, Cueff C, Boutron I, Detaint D. Size-adjusted left ventricular outflow tract diameter reference values: a safeguard for the evaluation of the severity of aortic stenosis. J Am Soc Echocardiogr. 2009;22:445–451

 This work was supported by grant 57445 from the Canadian Institutes of Health Research (Ottawa, ON, Canada). Dr Pibarot holds the Canada Research Chair in Valvular Heart Diseases at the Canadian Institutes of Health Research. Dr Mathieu is a research scholar at Fonds de Recherches en Santé du Québec (Montreal, QC, Canada).

PII: S0894-7317(10)00099-4

doi: 10.1016/j.echo.2010.02.002

Journal of the American Society of Echocardiography
Volume 23, Issue 4 , Pages 380-386 , April 2010

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