Related Experiment Video
Updated: Jun 4, 2026
04:48
Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Invasive transvalvular flow rate to predict likely severe aortic valve stenosis with low-gradient and normal ejection
Karim Elbasha1,2, Arief Kurniadi3, Mohamed Samy3,4
1Cardiology Department, Heart Centre, Segeberger Kliniken GmbH, Am Kurpak 1, 23795, Bad Segeberg, Germany. drkarim.elbasha@gmail.com.
Summary
In patients with low-gradient severe aortic stenosis (AS) and normal ejection fraction, low transvalvular flow rate (TFR) is a strong indicator of true AS severity. This finding improves long-term outcomes prediction after transcatheter aortic valve implantation (TAVI).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Echocardiography
Background:
- Limited data exists on the diagnostic utility of invasively measured transvalvular flow rate (TFR) in patients with low-gradient severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) prior to transcatheter aortic valve implantation (TAVI).
- Accurate diagnosis of severe AS is crucial for appropriate treatment selection in this patient cohort.
Purpose of the Study:
- To assess the role of invasively measured TFR as a diagnostic tool for identifying likely severe discordant AS in patients with low-gradient severe AS and normal LVEF.
- To evaluate the association between TFR and long-term cardiac mortality after TAVI.
Main Methods:
- A single-center registry included 134 patients with low-gradient severe AS and normal LVEF undergoing pre-TAVI invasive hemodynamic evaluation.
- Patients were categorized as having likely or unlikely severe AS based on European Society of Cardiology (ESC) guidelines.
- Transvalvular flow rate (TFR) and stroke volume index (SVi) were invasively measured and analyzed.
Main Results:
- Patients with likely severe AS exhibited a significantly lower TFR compared to those with unlikely severe AS (159 vs. 180 ml/s, p=0.044), despite comparable SVi.
- A TFR ≤ 200 ml/s was strongly associated with the diagnosis of likely severe AS (OR 3.09, p=0.010).
- Invasive TFR, unlike SVi, independently predicted 5-year cardiac mortality after TAVI (HR 0.45, p=0.042), with likely severe AS patients showing better outcomes.
Conclusions:
- Low invasive TFR is a reliable diagnostic marker for likely severe AS in patients with low gradients and preserved LVEF.
- The integration of TFR into diagnostic criteria aids in predicting long-term cardiac mortality post-TAVI.
- Patients with likely severe discordant AS and normal LV function demonstrate improved long-term survival following TAVI.
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
01:15Aortic Regurgitation I: Introduction
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
01:22Mitral Stenosis I: Introduction
Mitral Valve Stenosis (MVS) is a heart condition where the mitral valve narrows, impeding blood circulation from the left atrium to the left ventricle. The etiology and pathophysiology of this condition are multifaceted, leading to a cascade of cardiovascular complications.Causes of Mitral Valve StenosisRheumatic Heart Disease: It is the main cause of mitral valve stenosis, particularly in developing nations. This condition arises from rheumatic fever, an inflammatory illness resulting from...
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
01:25Aortic Regurgitation III: Medical Management
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
01:27Mitral Stenosis IV: Nursing Management
A comprehensive nursing assessment is essential for patients with valvular heart disease, which involves any dysfunction of the heart valves that could impact blood flow and overall heart function.Subjective Data Collection:Chief Complaint and Present Illness: Start with the patient's primary concerns, focusing on the onset, duration, and progression of cardiac symptoms such as dyspnea, fatigue, chest pain, and palpitations.Past Medical History: Collect detailed information on any previous...