Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis

The hemodynamic effects of aortic stenosis (AS) consist of increased left ventricular (LV) afterload, reduced myocardial compliance, and increased myocardial workload. The LV in AS patients faces a double load: valvular and arterial loads. As such, the presence of symptoms and occurrence of adverse...

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Autores principales:	Yogamaya Mantha, Shutaro Futami, Shohei Moriyama, Michinari Hieda
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	aortic stenosis valvulo-arterial impedance dimensionless index paradoxical low-flow low-gradient severe AS heart failure valvular heart disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/1831d076bf1d428f91a52d9fd9652178
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spelling	oai:doaj.org-article:1831d076bf1d428f91a52d9fd96521782021-12-02T08:41:52ZValvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis2297-055X10.3389/fcvm.2021.742297https://doaj.org/article/1831d076bf1d428f91a52d9fd96521782021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fcvm.2021.742297/fullhttps://doaj.org/toc/2297-055XThe hemodynamic effects of aortic stenosis (AS) consist of increased left ventricular (LV) afterload, reduced myocardial compliance, and increased myocardial workload. The LV in AS patients faces a double load: valvular and arterial loads. As such, the presence of symptoms and occurrence of adverse events in AS should better correlate with calculating the global burden faced by the LV in addition to the transvalvular gradient and aortic valve area (AVA). The valvulo-arterial impedance (Zva) is a useful parameter providing an estimate of the global LV hemodynamic load that results from the summation of the valvular and vascular loads. In addition to calculating the global LV afterload, it is paramount to estimate the stenosis severity accurately. In clinical practice, the management of low-flow low-gradient (LF-LG) severe AS with preserved LV ejection fraction requires careful confirmation of stenosis severity. In addition to the Zva, the dimensionless index (DI) is a very useful parameter to express the size of the effective valvular area as a proportion of the cross-section area of the left ventricular outlet tract velocity-time integral (LVOT-VTI) to that of the aortic valve jet (dimensionless velocity ratio). The DI is calculated by a ratio of the sub-valvular velocity obtained by pulsed-wave Doppler (LVOT-VTI) divided by the maximum velocity obtained by continuous-wave Doppler across the aortic valve (AV-VTI). In contrast to AVA measurement, the DI does not require the calculation of LVOT cross-sectional area, a major cause of erroneous assessment and underestimation of AVA. Hence, among patients with LG severe AS and preserved LV ejection fraction, calculation of DI in routine echocardiographic practice may be useful to identify a subgroup of patients at higher risk of mortality who may derive benefit from aortic valve replacement. This article aims to elucidate the Zva and DI in different clinical situations, correlate with the standard indexes of AS severity, LV geometry, and function, and thus prove to improve risk stratification and clinical decision making in patients with severe AS.Yogamaya ManthaShutaro FutamiShohei MoriyamaMichinari HiedaFrontiers Media S.A.articleaortic stenosisvalvulo-arterial impedancedimensionless indexparadoxical low-flow low-gradient severe ASheart failurevalvular heart diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENFrontiers in Cardiovascular Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	aortic stenosis valvulo-arterial impedance dimensionless index paradoxical low-flow low-gradient severe AS heart failure valvular heart disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	aortic stenosis valvulo-arterial impedance dimensionless index paradoxical low-flow low-gradient severe AS heart failure valvular heart disease Diseases of the circulatory (Cardiovascular) system RC666-701 Yogamaya Mantha Shutaro Futami Shohei Moriyama Michinari Hieda Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis
description	The hemodynamic effects of aortic stenosis (AS) consist of increased left ventricular (LV) afterload, reduced myocardial compliance, and increased myocardial workload. The LV in AS patients faces a double load: valvular and arterial loads. As such, the presence of symptoms and occurrence of adverse events in AS should better correlate with calculating the global burden faced by the LV in addition to the transvalvular gradient and aortic valve area (AVA). The valvulo-arterial impedance (Zva) is a useful parameter providing an estimate of the global LV hemodynamic load that results from the summation of the valvular and vascular loads. In addition to calculating the global LV afterload, it is paramount to estimate the stenosis severity accurately. In clinical practice, the management of low-flow low-gradient (LF-LG) severe AS with preserved LV ejection fraction requires careful confirmation of stenosis severity. In addition to the Zva, the dimensionless index (DI) is a very useful parameter to express the size of the effective valvular area as a proportion of the cross-section area of the left ventricular outlet tract velocity-time integral (LVOT-VTI) to that of the aortic valve jet (dimensionless velocity ratio). The DI is calculated by a ratio of the sub-valvular velocity obtained by pulsed-wave Doppler (LVOT-VTI) divided by the maximum velocity obtained by continuous-wave Doppler across the aortic valve (AV-VTI). In contrast to AVA measurement, the DI does not require the calculation of LVOT cross-sectional area, a major cause of erroneous assessment and underestimation of AVA. Hence, among patients with LG severe AS and preserved LV ejection fraction, calculation of DI in routine echocardiographic practice may be useful to identify a subgroup of patients at higher risk of mortality who may derive benefit from aortic valve replacement. This article aims to elucidate the Zva and DI in different clinical situations, correlate with the standard indexes of AS severity, LV geometry, and function, and thus prove to improve risk stratification and clinical decision making in patients with severe AS.
format	article
author	Yogamaya Mantha Shutaro Futami Shohei Moriyama Michinari Hieda
author_facet	Yogamaya Mantha Shutaro Futami Shohei Moriyama Michinari Hieda
author_sort	Yogamaya Mantha
title	Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis
title_short	Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis
title_full	Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis
title_fullStr	Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis
title_full_unstemmed	Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis
title_sort	valvulo-arterial impedance and dimensionless index for risk stratifying patients with severe aortic stenosis
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/1831d076bf1d428f91a52d9fd9652178
work_keys_str_mv	AT yogamayamantha valvuloarterialimpedanceanddimensionlessindexforriskstratifyingpatientswithsevereaorticstenosis AT shutarofutami valvuloarterialimpedanceanddimensionlessindexforriskstratifyingpatientswithsevereaorticstenosis AT shoheimoriyama valvuloarterialimpedanceanddimensionlessindexforriskstratifyingpatientswithsevereaorticstenosis AT michinarihieda valvuloarterialimpedanceanddimensionlessindexforriskstratifyingpatientswithsevereaorticstenosis
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Valvulo-Arterial Impedance and Dimensionless Index for Risk Stratifying Patients With Severe Aortic Stenosis

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