Author + information
- Received August 17, 2018
- Revision received November 12, 2018
- Accepted November 14, 2018
- Published online February 4, 2019.
- Victoria Delgado, MDa,
- Marie-Annick Clavel, DVM, PhDb,
- Rebecca T. Hahn, MDc,
- Linda Gillam, MDd,
- Jeroen Bax, MDa,
- Partho P. Sengupta, MDe and
- Philippe Pibarot, DVM, PhDb,∗ ()
- aDepartment of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
- bInstitut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
- cColumbia University Medical Center/NY Presbyterian Hospital, New York, New York
- dMorristown Medical Center/Atlantic Health System, Morristown, New Jersey
- eWest Virginia University Heart and Vascular Institute, Morgantown, West Virginia
- ↵∗Address for correspondence:
Dr. Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec City, Québec G1V-4G5, Canada.
Up to 40% of patients with aortic stenosis (AS) present with a “discordant grading” usually referred to as “low-gradient AS.” This article presents a step-by-step integrative approach overview of the utility, limitations, and complementary role of the different imaging modalities for the assessment of AS severity with a special emphasis on the reconciliation of discordant grading. The first step is to confirm the validity of echocardiographic measures of AS severity. For example, hybrid imaging can combine left ventricular outflow tract area measured by 3-dimensional echocardiography or contrast enhanced multidetector row computed tomography with flow velocities measured by Doppler. The next step is to differentiate severe from non-severe AS with the use of low-dose dobutamine stress echocardiography, especially in patients with low left ventricular ejection fraction, low-flow, low-gradient AS. Aortic valve calcium scoring measured by noncontrast multidetector row computed tomography is preferred in patients with low-gradient AS and preserved left ventricular ejection fraction as well as in those with inconclusive results with dobutamine stress echocardiography.
The Department of Cardiology of the Leiden University Medical Center has received unrestricted research grants from Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare, and Medtronic. Drs. Hahn and Pibarot have received a research grant from Edwards Lifesciences for echocardiography core laboratory analyses in the field of transcatheter aortic valve replacement. Dr. Delgado has received speaker fees from Abbott Vascular. Dr. Gillam oversees core laboratories that have research contracts with Edwards Lifesciences LLC and Medtronic; and is an advisor to Philips. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 17, 2018.
- Revision received November 12, 2018.
- Accepted November 14, 2018.
- 2019 American College of Cardiology Foundation
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