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Valvular Disease and Heart Failure: Aortic Stenosis

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Clinical Cases in Heart Failure

Part of the book series: Clinical Cases in Cardiology ((CCC))

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Abstract

A 74 year old male with a past medical history of hypertension, atrial fibrillation on warfarin and moderate aortic stenosis presented with recurrent admissions for decompensated heart failure with preserved ejection fraction. In addition to volume overload the patient complained of severe dyspnea on exertion; he denied exertional angina and syncope. He responded promptly to diuresis each hospitalization and was discharged on escalating doses of oral furosemide and beta-blockers for rate and blood pressure control. Repeat transthoracic echocardiogram demonstrated moderate concentric left ventricular (LV) hypertrophy, small LV size, LV ejection fraction of 60%, aortic valve area (AVA) of 0.5 cm2/m2, mean gradient of 28 mmHg, and stroke volume index of 30 ml/m2. A dobutamine stress echocardiogram showed an increase in LV ejection fraction to 70% with stress in addition to a fixed AVA of 0.5 cm2/m2 and an increase in mean gradient to 32 mmHg. His aortic valve calcium score by multidetector computed tomography was 2146 AU.

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References

  1. Hachicha Z, et al. Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007;115(22):2856–64.

    Article  PubMed  Google Scholar 

  2. Nishimura RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):e521–643.

    Article  PubMed  Google Scholar 

  3. Clavel MA, et al. Outcome of patients with aortic stenosis, small valve area, and low-flow, low-gradient despite preserved left ventricular ejection fraction. J Am Coll Cardiol. 2012;60(14):1259–67.

    Article  PubMed  Google Scholar 

  4. Lancellotti P, et al. Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification. J Am Coll Cardiol. 2012;59(3):235–43.

    Article  CAS  PubMed  Google Scholar 

  5. Eleid MF, et al. Flow-gradient patterns in severe aortic stenosis with preserved ejection fraction: clinical characteristics and predictors of survival. Circulation. 2013;128(16):1781–9.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mohty D, et al. Outcome and impact of surgery in paradoxical low-flow, low-gradient severe aortic stenosis and preserved left ventricular ejection fraction: a cardiac catheterization study. Circulation. 2013;128(11 Suppl 1):S235–42.

    Article  PubMed  Google Scholar 

  7. Maes F, et al. Natural history of paradoxical low-gradient severe aortic stenosis. Circ Cardiovasc Imaging. 2014;7(4):714–22.

    Article  PubMed  Google Scholar 

  8. Jander N, et al. Outcome of patients with low-gradient “severe” aortic stenosis and preserved ejection fraction. Circulation. 2011;123(8):887–95.

    Article  PubMed  Google Scholar 

  9. Tribouilloy C, et al. Low-gradient, low-flow severe aortic stenosis with preserved left ventricular ejection fraction: characteristics, outcome, and implications for surgery. J Am Coll Cardiol. 2015;65(1):55–66.

    Article  PubMed  Google Scholar 

  10. Herrmann S, et al. Low-gradient aortic valve stenosis myocardial fibrosis and its influence on function and outcome. J Am Coll Cardiol. 2011;58(4):402–12.

    Article  PubMed  Google Scholar 

  11. Lancellotti P, et al. Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study. Eur J Echocardiogr. 2010;11(6):537–43.

    Article  PubMed  Google Scholar 

  12. Adda J, et al. 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. 2012;5(1):27–35.

    Article  PubMed  Google Scholar 

  13. Lee SP, et al. Deterioration of myocardial function in paradoxical low-flow severe aortic stenosis: two-dimensional strain analysis. J Am Soc Echocardiogr. 2011;24(9):976–83.

    Article  PubMed  Google Scholar 

  14. Melis G, et al. Systolic volume index by Doppler echocardiography is an useful marker for stratification and prognostic evaluation in patients with severe aortic stenosis and preserved ejection fraction. Rev Esp Cardiol. 2013;66(4):261–8.

    Article  PubMed  Google Scholar 

  15. Pibarot P, Clavel MA. Management of paradoxical low-flow, low-gradient aortic stenosis: need for an integrated approach, including assessment of symptoms, hypertension, and stenosis severity. J Am Coll Cardiol. 2015;65(1):67–71.

    Article  PubMed  Google Scholar 

  16. Clavel MA, et al. Stress echocardiography to assess stenosis severity and predict outcome in patients with paradoxical low-flow, low-gradient aortic stenosis and preserved LVEF. JACC Cardiovasc Imaging. 2013;6(2):175–83.

    Article  PubMed  Google Scholar 

  17. Herrmann HC, et al. Predictors of mortality and outcomes of therapy in low-flow severe aortic stenosis: a placement of aortic transcatheter valves (PARTNER) trial analysis. Circulation. 2013;127(23):2316–26.

    Article  PubMed  Google Scholar 

  18. Ozkan A, et al. Impact of aortic valve replacement on outcome of symptomatic patients with severe aortic stenosis with low gradient and preserved left ventricular ejection fraction. Circulation. 2013;128(6):622–31.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Brown University, Providence, RI, USA

    Steven Gannon & Siddique A. Abbasi

Authors
  1. Steven Gannon
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  2. Siddique A. Abbasi
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Correspondence to Siddique A. Abbasi .

Editor information

Editors and Affiliations

  1. Department of Medicine and Cardiology , Massachusetts General Hospital , Boston, Massachusetts, USA

    Ravi V. Shah

  2. Providence VA Medical Center, Providence, Rhode Island, USA

    Siddique A. Abbasi

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Gannon, S., Abbasi, S.A. (2018). Valvular Disease and Heart Failure: Aortic Stenosis. In: Shah, R., Abbasi, S. (eds) Clinical Cases in Heart Failure. Clinical Cases in Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-319-65804-9_5

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  • DOI: https://doi.org/10.1007/978-3-319-65804-9_5

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65803-2

  • Online ISBN: 978-3-319-65804-9

  • eBook Packages: MedicineMedicine (R0)

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