Resting Aortic Valve Area at Normal Transaortic Flow Rate Reflects True Valve Area in Suspected Low Gradient Severe XXXX .

@entity1 @entity5427 @entity64 @entity886 @entity472 @entity1642
OBJECTIVES: This study sought to assess the diagnostic impact of @entity1642 ( @entity1642 ) in @entity1 with suspected low-flow, low-gradient @entity472 but normal resting transvalvular flow rate. BACKGROUND: @entity1642 may help to distinguish between true severe @entity472 and pseudosevere @entity472 in @entity1 with @entity886 (AVA) and mean gradient. However, if rest flow rate is normal, then @entity1642 may not confer any additional diagnostic value, irrespective of resting left ventricular ejection fraction (LVEF) and indexed @entity64 volume  (SVi). METHODS: Sixty-seven @entity1 with suspected low-flow, low-gradient @entity472 who underwent @entity1642 were retrospectively studied. Following stratification by rest LVEF, SVi, and flow rate-using cutoffs of 50%, 35 ml/m(2), and 200  ml/s, respectively-we tested for significant changes in AVA during @entity1642 . RESULTS: Mean age was 77    9 years and 60% of @entity1 were male. Mean values for rest variables were as follow: AVA:  0.77    0.12 cm(2); mean gradient: 27    7 mm  Hg; flow rate: 182    37 ml/s; SVi: 32    8 ml/m(2); and LVEF: 45    15%. During  @entity1642 , significant increases in AVA were observed regardless of resting LVEF and SVi state. In @entity1 with rest flow rate  >= 200  ml/s, AVA did not increase significantly during stress (rest AVA: 0.90 cm(2) vs. stress AVA: 0.97 cm(2); p  =  0.11), and positive predictive value for confirming underlying true severe @entity472 was 84%. In adjusted analyses, rest flow rate was the only parameter associated with severe @entity5427 (odds ratio: 1.05, 95% confidence interval: 1.0  to  1.1; p  = 0.002). CONCLUSIONS: Rest AVA measured under normal flow rate conditions is likely to reflect the true severity of @entity5427 and unlikely to change significantly with @entity1642 . Flow normalization may only be required in @entity1 with AVA  <1 cm(2) and mean gradient  <40 mm  Hg when the rest flow rate is  <200 ml/s.
