Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient

Nanea, Ioan Tiberiu; Nicolae, Camelia; Iliesiu, Adriana Mihaela; Plesa, Florentina Cristina; Ples, Liana; Munteanu, Alice; Diaconu, Magdalena; Bisoc, Alina; Ciucurel, Constantin; Iconaru, Elena Ioana; Paunescu, Alina

Ioan Tiberiu Nanea, Camelia Nicolae, Adriana Mihaela Iliesiu, Florentina Cristina Plesa, Liana Ples, Alice Munteanu, Magdalena Diaconu, Alina Bisoc, Constantin Ciucurel, Elena Ioana Iconaru, Alina Paunescu

Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient

Abstract:

Purpose of the study: echocardiographic evaluation of the form of degenerative aortic stenosis (DAS) with preserved ejection fraction (EF) and low transvalvular gradient, in order to formulate the indication of valvular prosthesis as early as possible; retrospective observational study that includes patients admitted or sent for ambulatory evaluation by other medical services. The echocardiographic parameters used: systolic and diastolic indices, tissue and spectral, mitral and tricuspid veins, aortic orifice area, maximal aortic systolic velocity, maximal and medium aortic transvalvular gradient, myocardial mass index, volume of left atrium, left ventricular (LV) thickness. 42 patients with severe DAS and preserved EF, average age 71.7±3.85 years. Two groups were isolated: A - with increased gradient (22 patients) and B - with low gradient (20 patients). The gender distribution was comparable: women representing 33% in group A versus 30% in group B. The average age of women in both groups was higher than that of the men: in group A: 72±8 years in the case of women vs. 67±6 years in the case of men and in group B 72±3.5 years in women vs. 68±6 years in men. Apical displacement of the mitral ring: 14±2mm in lot A vs. 11±2mm in lot B. Myocardial mass index: 120 ± 9g/m2 in lot A vs. 126 ± 12g/m2 in lot B. Left ventricular filling ratio E/e’: 8±2 in lot A vs. 13±2 in lot B; maximum aortic systolic velocity: 4.3±0.9m/s in lot A vs. 3.1±0.8m/s in lot B; maximum gradient: 73.9±10mmHg in lot A vs. 37±12mmHg in lot B; aortic orifice area: 0.80±10.5 in lot A vs. 0.79±0.07 in lot B. Statistical analysis shows the Pearson correlation index r with the highest values of 95% at the significance threshold between the aortic orifice area and the valve opening (r=0.87), the ratio E/e’ (r=-0.85) and diastolic thickness of the posterior wall of the aortic left ventricle (r = 0.78). Aortic stenosis with preserved ejection fraction and low gradient was more common in men. The filling ratio E/e’ was increased (13 ± 2) in group B, suggesting the increase of filling pressures of LV in patients with DAS and low transvalvular gradient. Tissue spectral systolic and longitudinal velocities were lower in group B, suggesting the onset of systolic LV dysfunction. The aortic valve opening and the E/e’ ratio showed the highest correlation coefficient with the area of the aortic orifice in both groups. The myocardial mass index and the thickness of the walls of the LV cavity are similar in the two groups, suggesting that the reduction of the LV cavity through hypertrophy may not explain, at least in totality, the form of DAS with low gradient and preserved ejection fraction.

Keywords:
degenerative aortic stenosis; transvalvular flow; ejection fraction; gradient; orifice area

Issue: 2019, Volume 70, Issue 9

Pages: 3142-3147

Publication date: 2019/10/15

https://doi.org/10.37358/RC.19.9.7504

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This article is published under the Creative Commons Attribution 4.0 International License

Citation Styles

Cite this article as:
NANEA, I.T., NICOLAE, C., ILIESIU, A.M., PLESA, F.C., PLES, L., MUNTEANU, A., DIACONU, M., BISOC, A., CIUCUREL, C., ICONARU, E.I., PAUNESCU, A., Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient, Rev. Chim., 70(9), 2019, 3142-3147.

Vancouver
Nanea IT, Nicolae C, Iliesiu AM, Plesa FC, Ples L, Munteanu A, Diaconu M, Bisoc A, Ciucurel C, Iconaru EI, Paunescu A. Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient. Rev. Chim.[internet]. 2019 Sep;70(9):3142-3147. Available from: https://doi.org/10.37358/RC.19.9.7504

APA 6th edition
Nanea, I.T., Nicolae, C., Iliesiu, A.M., Plesa, F.C., Ples, L., Munteanu, A.,... Paunescu, A. (2019). Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient. Revista de Chimie, 70(9), 3142-3147. https://doi.org/10.37358/RC.19.9.7504

Harvard
Nanea, I.T., Nicolae, C., Iliesiu, A.M., Plesa, F.C., Ples, L., Munteanu, A., Diaconu, M., Bisoc, A., Ciucurel, C., Iconaru, E.I., Paunescu, A. (2019). 'Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient', Revista de Chimie, 70(9), pp. 3142-3147. https://doi.org/10.37358/RC.19.9.7504

IEEE
I.T. Nanea, C. Nicolae, A.M. Iliesiu, F.C. Plesa, L. Ples, A. Munteanu, M. Diaconu, A. Bisoc, C. Ciucurel, E.I. Iconaru, A. Paunescu, "Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient". Revista de Chimie, vol. 70, no. 9, pp. 3142-3147, 2019. [online]. https://doi.org/10.37358/RC.19.9.7504

Text
Ioan Tiberiu Nanea, Camelia Nicolae, Adriana Mihaela Iliesiu, Florentina Cristina Plesa, Liana Ples, Alice Munteanu, Magdalena Diaconu, Alina Bisoc, Constantin Ciucurel, Elena Ioana Iconaru, Alina Paunescu,
Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient,
Revista de Chimie,
Volume 70, Issue 9,
2019,
Pages 3142-3147,
ISSN 2668-8212,
https://doi.org/10.37358/RC.19.9.7504.
(https://revistadechimie.ro/Articles.asp?ID=7504)
Keywords: degenerative aortic stenosis; transvalvular flow; ejection fraction; gradient; orifice area

RIS
TY - JOUR
T1 - Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient
A1 - Nanea, Ioan Tiberiu
A2 - Nicolae, Camelia
A3 - Iliesiu, Adriana Mihaela
A4 - Plesa, Florentina Cristina
A5 - Ples, Liana
A6 - Munteanu, Alice
A7 - Diaconu, Magdalena
A8 - Bisoc, Alina
A9 - Ciucurel, Constantin
A10 - Iconaru, Elena Ioana
A11 - Paunescu, Alina
JF - Revista de Chimie
JO - Rev. Chim.
PB - Revista de Chimie SRL
SN - 2668-8212
Y1 - 2019
VL - 70
IS - 9
SP - 3142
EP - 3147
UR - https://doi.org/10.37358/RC.19.9.7504
KW - degenerative aortic stenosis
KW - transvalvular flow
KW - ejection fraction
KW - gradient
KW - orifice area
ER -

BibTex
@article{RevCh2019P3142,
author = {Nanea Ioan Tiberiu and Nicolae Camelia and Iliesiu Adriana Mihaela and Plesa Florentina Cristina and Ples Liana and Munteanu Alice and Diaconu Magdalena and Bisoc Alina and Ciucurel Constantin and Iconaru Elena Ioana and Paunescu Alina},
title = {Transtoracical Ecocardiographic Assessment of Severe Degenerative Aortic Stenosis with Normal Ejection Fraction and Low Transvalvular Gradient},
journal = {Revista de Chimie},
volume = {70},
number = {9},
pages = {3142-3147},
year = {2019},
issn = {2668-8212},
doi = {https://doi.org/10.37358/RC.19.9.7504},
url = {https://revistadechimie.ro/Articles.asp?ID=7504}
}

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