Skip to main content
Log in

„Low-flow-low-gradient“-Aortenklappenstenose

Aktuelle Evidenz

Low-flow low-gradient aortic valve stenosis

Current evidence

  • Schwerpunkt
  • Published:
Herz Aims and scope Submit manuscript

Zusammenfassung

Ein bedeutender Anteil an Patienten mit einer schwergradigen Stenosierung der Aortenklappen in der Ruheechokardiographie haben eine „Low-flow-low-gradient“-Aortenklappenstenose. Das diagnostische und therapeutische Management dieser Patienten sind komplex, da häufig eine linksventrikuläre Funktionseinschränkung vorliegt, die ein höheres Risiko bei operativem Klappenersatz bedingt und den Stenosegrad in der Echokardiographie verfälschen kann. Es sind teils mehrere diagnostische Schritte notwendig, um diese Patienten eindeutig zu diagnostizieren und der optimalen Therapie zuzuführen.

Abstract

Many patients with severe aortic stenosis have a “low-flow, low-gradient” aortic stenosis. The management of these patients can be quite difficult, as these patients often show impairment of the left ventricle, which can lead to false measurements of the severity of stenosis and also leads to a higher risk during aortic valve replacement. More diagnostic tools than only standard echocardiography are needed to correctly differentiate true severe aortic stenosis from pseudo severe aortic stenosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Iung B, Baron G, Butchart EG et al (2003) A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24(13):1231–1243

    Article  PubMed  Google Scholar 

  2. Vahanian A, Alfieri O, Andreotti F et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33(19):2451–2496

    Article  PubMed  Google Scholar 

  3. Clavel MA, Pibarot P (2014) Assessment of low-flow, low-gradient aortic stenosis: multimodality imaging is the key to success. EuroIntervention 10(Suppl U):U52–U60

    Article  PubMed  Google Scholar 

  4. Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P (2007) Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation 115(22):2856–2864

    Article  PubMed  Google Scholar 

  5. Adda J, Mielot C, Giorgi R et al (2012) Low-flow, low-gradient severe aortic stenosis despite normal ejection fraction is associated with severe left ventricular dysfunction as assessed by speckle-tracking echocardiography: a multicenter study. Circ Cardiovasc Imaging 5(1):27–35

    Article  PubMed  Google Scholar 

  6. Ozkan A (2012) Low gradient “severe” aortic stenosis with preserved left ventricular ejection fraction. Cardiovasc Diagn Ther 2(1):19–27

    PubMed  PubMed Central  Google Scholar 

  7. Burwash IG, Thomas DD, Sadahiro M et al (1994) Dependence of Gorlin formula and continuity equation valve areas on transvalvular volume flow rate in valvular aortic stenosis. Circulation 89(2):827–835

    Article  CAS  PubMed  Google Scholar 

  8. Dahou A, Magne J, Clavel MA et al (2015) Tricuspid regurgitation is associated with increased risk of mortality in patients with low-flow low-gradient aortic stenosis and reduced ejection fraction: results of the multicenter TOPAS study (true or pseudo-severe aortic Stenosis). JACC Cardiovasc Interv 8(4):588–596

    Article  PubMed  Google Scholar 

  9. Clavel MA, Burwash IG, Pibarot P (2017) Cardiac imaging for assessing low-gradient severe aortic Stenosis. JACC Cardiovasc Imaging 10(2):185–202

    Article  PubMed  Google Scholar 

  10. Cueff C, Serfaty JM, Cimadevilla C et al (2011) Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart 97(9):721–726

    Article  PubMed  Google Scholar 

  11. Messika-Zeitoun D, Aubry M‑C, Detaint D et al (2004) Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography. Circulation 110(3):356–362

    Article  PubMed  Google Scholar 

  12. Nishimura RA, Otto CM, Bonow RO et al (2014) AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129(23):2440–2492

    Article  PubMed  Google Scholar 

  13. Nishimura RA, Grantham JA, Connolly HM et al (2002) 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 106(7):809–813

    Article  PubMed  Google Scholar 

  14. Blais C, Burwash IG, Mundigler G et al (2006) Projected valve area at normal flow rate improves the assessment of Stenosis severity in patients with low-flow, low-gradient aortic Stenosis. Circulation 113(5):711–721

    Article  PubMed  Google Scholar 

  15. Monin JL, Quere JP, Monchi M et al (2003) Low-gradient aortic Stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation 108(3):319–324

    Article  PubMed  Google Scholar 

  16. Quere J‑P, Monin J‑L, Levy F et al (2006) Influence of preoperative left ventricular contractile reserve on postoperative ejection fraction in low-gradient aortic Stenosis. Circulation 113(14):1738–1744

    Article  PubMed  Google Scholar 

  17. Levy F, Laurent M, Monin JL et al (2008) 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 51(15):1466–1472

    Article  PubMed  Google Scholar 

  18. Clavel M‑A, Messika-Zeitoun D, Pibarot P et al (2013) The complex nature of discordant severe calcified aortic valve disease grading. J Am Coll Cardiol 62(24):2329–2338

    Article  CAS  PubMed  Google Scholar 

  19. Clavel MA, Fuchs C, Burwash IG et al (2008) Predictors of outcomes in low-flow, low-gradient aortic stenosis: results of the multicenter TOPAS Study. Circulation 118(14 Suppl):S234–S242

    Article  PubMed  Google Scholar 

  20. Connolly HM, Oh JK, Schaff HV et al (2000) Severe aortic Stenosis with low transvalvular gradient and severe left ventricular dysfunction. Circulation 101(16):1940–1946

    Article  CAS  PubMed  Google Scholar 

  21. Tribouilloy C, Levy F, Rusinaru D et al (2009) Outcome after aortic valve replacement for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol 53(20):1865–1873

    Article  PubMed  Google Scholar 

  22. Dahou A, Bartko PE, Capoulade R et al (2015) Usefulness of global left ventricular longitudinal strain for risk stratification in low ejection fraction, low-gradient aortic stenosis: results from the multicenter True or Pseudo-Severe Aortic Stenosis study. Circ Cardiovasc Imaging 8(3):e002117

    Article  PubMed  Google Scholar 

  23. Eleid MF, Sorajja P, Michelena HI et al (2013) Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival. Circulation 128(16):1781–1789

    Article  PubMed  PubMed Central  Google Scholar 

  24. Dumesnil JG, Pibarot P, Carabello B (2010) Paradoxical low flow and/or low gradient severe aortic stenosis despite preserved left ventricular ejection fraction: implications for diagnosis and treatment. Eur Heart J 31(3):281–289

    Article  PubMed  Google Scholar 

  25. Herrmann S, Stork S, al Niemann Met (2011) Low-gradient aortic valve stenosis myocardial fibrosis and its influence on function and outcome. J Am Coll Cardiol 58(4):402–412

    Article  PubMed  Google Scholar 

  26. Herrmann HC, Pibarot P, Hueter I et al (2013) Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: a Placement of Aortic Transcatheter Valves (PARTNER) trial analysis. Circulation 127(23):2316–2326

    Article  PubMed  Google Scholar 

  27. Clavel MA, Magne J, Pibarot P (2016) Low-gradient aortic stenosis. Eur Heart J 37(34):2645–2657

    Article  PubMed  PubMed Central  Google Scholar 

  28. Clavel MA, Berthelot-Richer M, Le Ven F et al (2015) Impact of classic and paradoxical low flow on survival after aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol 65(7):645–653

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. A. Sherif MD, PhD.

Ethics declarations

Interessenkonflikt

F. Tillwich, M. A. Sherif, S. Yücel, A. Öner und H. Ince geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tillwich, F., Sherif, M.A., Yücel, S. et al. „Low-flow-low-gradient“-Aortenklappenstenose. Herz 42, 536–541 (2017). https://doi.org/10.1007/s00059-017-4588-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-017-4588-8

Schlüsselwörter

Keywords

Navigation