A Novel Echocardiographic Parameter to Confirm Low-Gradient Aortic Stenosis Severity

Sébastien Hecht, MSc; Mohamed-Salah Annabi, MD, MSc; Viktória Stanová, PhD; Abdellaziz Dahou, MD, PhD; Ian G. Burwash, MD; Matthias Koschutnik, MD; Philipp E. Bartko, MD; Jutta Bergler-Klein, MD; Julia Mascherbauer, MD; Carolina Donà, MD; Stefan Orwat, MD; Helmut Baumgartner, MD; Joao L. Cavalcante, MD; Henrique B. Ribeiro, MD, PhD; Alexis Théron, MD, PhD; Josep Rodes-Cabau, MD; Marie-Annick Clavel, DVM, PhD; Philippe Pibarot, DVM, PhD

JACC: Advances (Oct 2024)

A Novel Echocardiographic Parameter to Confirm Low-Gradient Aortic Stenosis Severity

Sébastien Hecht, MSc,
Mohamed-Salah Annabi, MD, MSc,
Viktória Stanová, PhD,
Abdellaziz Dahou, MD, PhD,
Ian G. Burwash, MD,
Matthias Koschutnik, MD,
Philipp E. Bartko, MD,
Jutta Bergler-Klein, MD,
Julia Mascherbauer, MD,
Carolina Donà, MD,
Stefan Orwat, MD,
Helmut Baumgartner, MD,
Joao L. Cavalcante, MD,
Henrique B. Ribeiro, MD, PhD,
Alexis Théron, MD, PhD,
Josep Rodes-Cabau, MD,
Marie-Annick Clavel, DVM, PhD,
Philippe Pibarot, DVM, PhD

Affiliations

Sébastien Hecht, MSc: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada
Mohamed-Salah Annabi, MD, MSc: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada
Viktória Stanová, PhD: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada
Abdellaziz Dahou, MD, PhD: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada
Ian G. Burwash, MD: Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Matthias Koschutnik, MD: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
Philipp E. Bartko, MD: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
Jutta Bergler-Klein, MD: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
Julia Mascherbauer, MD: Karl Landsteiner University of Health Sciences, Department of Internal Medicine 3, University Hospital St. Pölten, Krems, Austria
Carolina Donà, MD: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
Stefan Orwat, MD: Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
Helmut Baumgartner, MD: Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
Joao L. Cavalcante, MD: Department of Cardiology, Minneapolis Heart Institute, Cardiology, Minneapolis, United States; Division of Cardiology, University of Pittsburgh, Pittsburgh, United States
Henrique B. Ribeiro, MD, PhD: Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
Alexis Théron, MD, PhD: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada; Department of Cardiac Surgery, La Timone Public Hospital, Marseille, France
Josep Rodes-Cabau, MD: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada
Marie-Annick Clavel, DVM, PhD: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada
Philippe Pibarot, DVM, PhD: Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada; Address for correspondence: Dr Philippe Pibarot, Institut universitaire de cardiologie et de pneumologie de Québec/Quebec Heart and Lung Institute, 2725 Chemin Sainte-Foy, Québec City, Québec G1V 4G5, Canada.

Journal volume & issue: Vol. 3, no. 10
p. 101245

Abstract

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Background: In patients with low-gradient (LG) aortic stenosis (AS), confirming disease severity and indication of intervention often requires dobutamine stress echocardiography (DSE) or aortic valve calcium scoring by computed tomography. We hypothesized that the mean transvalvular pressure gradient to effective orifice area ratio (MG/EOA, in mm Hg/cm2) measured during rest echocardiography identifies true-severe AS (TSAS) and is associated with clinical outcomes in patients with low-flow, LG-AS. Objectives: The purpose of this study was to evaluate the diagnostic and prognostic value of MG/EOA ratio. Methods: The diagnostic accuracy of MG/EOA ratio to identify TSAS was retrospectively assessed in: 1) an in vitro data set obtained in a circulatory model including 93 experimental conditions; and 2) an in vivo data set of 188 patients from the TOPAS (True or Pseudo-Severe Aortic Stenosis) study (NCT01835028). Receiver operating characteristic curves were used to assess the diagnostic accuracy of MG/EOA ratio for identifying TSAS, and Cox proportional hazards regression analyses were performed to assess its association with clinical outcomes. Results: The optimal cutoff of MG/EOA ratio to identify TSAS in patients with low-flow, LG-AS was ≥25 mm Hg/cm2 (correct classification 85%), as well as in vitro (100%). During a median follow-up of 1.41 ± 0.75 years, 146 (78%) patients met the composite endpoint of aortic valve replacement or all-cause mortality. A MG/EOA ratio ≥25 mm Hg/cm2 was independently associated with an increased risk of the composite endpoint (adjusted HR: 2.36 [95% CI: 1.63-3.42], P < 0.001). The Harell’s C-index of MG/EOA was 0.68, equaling projected EOA (0.67) measured by DSE. Conclusions: MG/EOA ratio can be useful in low-flow, LG-AS to confirm AS severity and may complement DSE or aortic valve calcium scoring.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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