Low-Output, Low-Gradient Aortic Stenosis in Patients With Depressed Left Ventricular Systolic Function
- 13 August 2002
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 106 (7), 809-813
- https://doi.org/10.1161/01.cir.0000025611.21140.34
Abstract
Background— Although aortic valve replacement can be performed at an acceptable risk level in selected patients with left ventricular systolic dysfunction and low-output, low-gradient aortic stenosis, not all patients presenting with these hemodynamics will benefit from the operation. Some patients may have only mild aortic stenosis, despite a small calculated valve area. We report on the clinical utility of diagnostic dobutamine stimulation during cardiac catheterization in these diagnostically challenging patients. Methods and Results— Thirty-two patients with low-output, low-gradient aortic stenosis and an ejection fraction 30 mm Hg were found to have severe calcific aortic stenosis at operation. In the 15 patients in whom contractile reserve was identified during dobutamine challenge (increase in stroke volume >20%), 1 patient died perioperatively (7% mortality) and 12 patients were alive in New York Heart Association class I or II status at follow-up. Conclusions— In patients with left ventricular systolic dysfunction and aortic stenosis with a low output and a low mean gradient, dobutamine challenge may aid in selecting those who would benefit from an aortic valve operation.Keywords
This publication has 10 references indexed in Scilit:
- Dobutamine Echocardiography in Patients With Aortic Stenosis and Left Ventricular DysfunctionChest, 2001
- Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradientsJournal of the American College of Cardiology, 2001
- ACC/AHA guidelines for the management of patients with valvular heart diseaseJournal of the American College of Cardiology, 1998
- Usefulness of dobutamine echocardiography in distinguishing severe from nonsevere valvular aortic stenosis in patients with depressed left ventricular function and low transvalvular gradientsThe American Journal of Cardiology, 1995
- Prognosis after valve replacement in patients with severe aortic stenosis and a low transvalvular pressure gradientJournal of the American College of Cardiology, 1993
- Aortic valve resistance as an adjunct to the gorlin formula in assessing the severity of aortic stenosis in symptomatic patientsJournal of the American College of Cardiology, 1992
- Effects of dobutamine on Gorlin and continuity equation valve areas and valve resistance in valvular aortic stenosisThe American Journal of Cardiology, 1992
- Reversal of Advanced Left Ventricular Dysfunction Following Aortic Valve Replacement for Aortic StenosisThe Annals of Thoracic Surgery, 1977
- Afterload mismatch and preload reserve: A conceptual framework for the analysis of ventricular functionProgress in Cardiovascular Diseases, 1976
- Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. IAmerican Heart Journal, 1951