Energy Loss Index and Dimensionless Index Outperform Direct Valve Planimetry in Low-Gradient Aortic Stenosis.

Details

Serval ID
serval:BIB_EB08FBEDC7A1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Energy Loss Index and Dimensionless Index Outperform Direct Valve Planimetry in Low-Gradient Aortic Stenosis.
Journal
Journal of clinical medicine
Author(s)
Hugelshofer S., de Brito D., Antiochos P., Tzimas G., Rotzinger D.C., Auberson D., Vella A., Fournier S., Kirsch M., Muller O., Monney P.
ISSN
2077-0383 (Print)
ISSN-L
2077-0383
Publication state
Published
Issued date
30/05/2024
Peer-reviewed
Oui
Volume
13
Number
11
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Background/Objectives: Among patients with suspected severe aortic stenosis (AS), discordance between effective orifice area (EOA) and transvalvular gradients is frequent and requires a multiparametric workup including flow assessment and calcium-scoring to confirm true severe AS. The aim of this study was to assess direct planimetry, energy loss index (Eli) and dimensionless index (DI) as stand-alone parameters to identify non-severe AS in discordant cases. Methods: In this prospective cohort study, we included consecutive AS patients > 70 years with EOA < 1.0 cm <sup>2</sup> referred for valve replacement between 2014 and 2017. AS severity was retrospectively reassessed using the multiparametric work-up recommended in the 2021 ESC/EACTS guidelines. DI and ELi were calculated, and valve area was measured by direct planimetry on transesophageal echocardiography. Results: A total of 101 patients (mean age 82 y; 57% male) were included. Discordance between EOA and gradients was observed in 46% and non-severe AS found in 24% despite an EOA < 1 cm <sup>2</sup> . Valve planimetry performed poorly, with an area under the ROC curve (AUC) of 0.64. At a cut-off value of >0.82 cm <sup>2</sup> , sensitivity and specificity to identify non-severe AS were 67 and 66%, respectively. DI and ELi showed a higher diagnostic accuracy, with an AUC of 0.77 and 0.76, respectively. Cut-off values of >0.24 and >0.6 cm <sup>2</sup> /m <sup>2</sup> identified non-severe AS, with a high specificity of 79% and 91%, respectively. Conclusions: Almost one in four patients with EOA < 1 cm <sup>2</sup> had non-severe AS according to guideline-recommended multiparametric assessment. Direct valve planimetry revealed poor diagnostic accuracy and should be interpreted with caution. Usual prognostic cut-off values for DI > 0.24 and ELI > 0.6 cm <sup>2</sup> /m <sup>2</sup> identified non-severe AS with high specificity and should therefore be included in the assessment of low-gradient AS.
Keywords
dimensionless index, echocardiography, energy loss index, low-gradient aortic stenosis, multiparametric assessment
Pubmed
Web of science
Open Access
Yes
Create date
21/06/2024 8:31
Last modification date
26/07/2024 6:01
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