The Experts below are selected from a list of 291 Experts worldwide ranked by ideXlab platform
Philippe Pibarot - One of the best experts on this subject based on the ideXlab platform.
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Coronary Microcirculation in Aortic Stenosis.
Circulation. Cardiovascular interventions, 2019Co-Authors: Hannah Mcconkey, Michael S. Marber, Amedeo Chiribiri, Philippe Pibarot, Simon Redwood, Bernard PrendergastAbstract:Aortic Stenosis is a heterogeneous disorder. Variations in the pathological and physiological responses to pressure overload are incompletely understood and generate a range of flow and pressure gradient patterns, which ultimately cause varying microvascular effects. The impact of cardiac-coronary coupling depends on these pressure and flow effects. In this article, we explore important concepts concerning cardiac physiology and the coronary microcirculation in Aortic Stenosis and their impact on myocardial remodeling, Aortic valve flow patterns, and clinical progression.
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Stress Testing in Asymptomatic Aortic Stenosis.
Circulation, 2017Co-Authors: Björn Redfors, Philippe Pibarot, Martin B. Leon, Brian R. Lindman, Robert O Bonow, Linda D. Gillam, Daniel Burkhoff, Jeroen J. Bax, Patrick T. O'gara, Philippe GénéreuxAbstract:Aortic Stenosis is 1 of the most common heart valve diseases among adults. When symptoms develop, prognosis is poor, and current guidelines recommend prompt Aortic valve replacement. Depending of the severity of the Aortic Stenosis and the presence of concomitant heart disease and medical comorbidities, stress testing represents a reasonable strategy to help better risk stratify asymptomatic patients. The present report provides a comprehensive review of the current available data on stress testing in Aortic Stenosis and subsequently summarizes its potential for guiding the optimal timing of Aortic valve replacement.
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Dilemma in the therapeutic management of low-gradient Aortic Stenosis.
Current opinion in cardiology, 2017Co-Authors: Marie-annick Clavel, Nancy Côté, Philippe PibarotAbstract:PURPOSE OF REVIEW Grading of Aortic Stenosis is essential in Aortic Stenosis management patients. However, despite clear thresholds provided in the guidelines, up to 30% of patients have discordant grading of Aortic Stenosis. The management of patients with low gradients/velocity despite tight Aortic valve area is challenging. RECENT FINDINGS Recent studies demonstrated that patients with or without low flow may have a severe Aortic Stenosis despite a low gradient. Moreover, Aortic valve replacement has been shown to improve outcome in low-gradient Aortic Stenosis patients with or without low flow. Finally, measurement of Aortic valve calcification by multidetector computed tomography is an important tool to assess Aortic Stenosis severity in these patients. SUMMARY The presence of a low gradient/velocity despite a tight Aortic valve area could be linked to low ejection fraction or low flow with preserved ejection fraction but also with normal flow and normal ejection fraction. In each situation, Aortic Stenosis could be truly severe or pseudosevere, and the severity of Aortic Stenosis has to be accurately evaluated for clinical decision-making. Nowadays, two types of interventions are available: surgical and transcatheter Aortic valve replacement, whereas conservative management should be considered as a palliative treatment in patients with proven severe Aortic Stenosis and symptoms or left ventricle dysfunction.
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Low-gradient Aortic Stenosis
European Heart Journal, 2016Co-Authors: Marie-annick Clavel, Julien Magne, Philippe PibarotAbstract:An important proportion of patients with Aortic Stenosis (AS) have a 'low-gradient' AS, i.e. a small Aortic valve area (AVA
Philippe Généreux - One of the best experts on this subject based on the ideXlab platform.
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Stress Testing in Asymptomatic Aortic Stenosis.
Circulation, 2017Co-Authors: Björn Redfors, Philippe Pibarot, Martin B. Leon, Brian R. Lindman, Robert O Bonow, Linda D. Gillam, Daniel Burkhoff, Jeroen J. Bax, Patrick T. O'gara, Philippe GénéreuxAbstract:Aortic Stenosis is 1 of the most common heart valve diseases among adults. When symptoms develop, prognosis is poor, and current guidelines recommend prompt Aortic valve replacement. Depending of the severity of the Aortic Stenosis and the presence of concomitant heart disease and medical comorbidities, stress testing represents a reasonable strategy to help better risk stratify asymptomatic patients. The present report provides a comprehensive review of the current available data on stress testing in Aortic Stenosis and subsequently summarizes its potential for guiding the optimal timing of Aortic valve replacement.
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Medical Treatment of Aortic Stenosis.
Circulation, 2016Co-Authors: Guillaume Marquis-gravel, Björn Redfors, Martin B. Leon, Philippe GénéreuxAbstract:Untreated, severe, symptomatic Aortic Stenosis is associated with a dismal prognosis. The only treatment shown to improve survival is Aortic valve replacement; however, before symptoms occur, Aortic Stenosis is preceded by a silent, latent phase characterized by a slow progression at the molecular, cellular, and tissue levels. In theory, specific medical therapy should halt Aortic Stenosis progression, reduce its hemodynamic repercussions on left ventricular function and remodeling, and improve clinical outcomes. In the present report, we performed a systematic review of studies focusing on the medical treatment of patients with Aortic Stenosis. Lipid-lowering therapy, antihypertensive drugs, and anticalcific therapy have been the main drug classes studied in this setting and are reviewed in depth. A critical appraisal of the preclinical and clinical evidence is provided, and future research avenues are presented.
Marie-annick Clavel - One of the best experts on this subject based on the ideXlab platform.
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Dilemma in the therapeutic management of low-gradient Aortic Stenosis.
Current opinion in cardiology, 2017Co-Authors: Marie-annick Clavel, Nancy Côté, Philippe PibarotAbstract:PURPOSE OF REVIEW Grading of Aortic Stenosis is essential in Aortic Stenosis management patients. However, despite clear thresholds provided in the guidelines, up to 30% of patients have discordant grading of Aortic Stenosis. The management of patients with low gradients/velocity despite tight Aortic valve area is challenging. RECENT FINDINGS Recent studies demonstrated that patients with or without low flow may have a severe Aortic Stenosis despite a low gradient. Moreover, Aortic valve replacement has been shown to improve outcome in low-gradient Aortic Stenosis patients with or without low flow. Finally, measurement of Aortic valve calcification by multidetector computed tomography is an important tool to assess Aortic Stenosis severity in these patients. SUMMARY The presence of a low gradient/velocity despite a tight Aortic valve area could be linked to low ejection fraction or low flow with preserved ejection fraction but also with normal flow and normal ejection fraction. In each situation, Aortic Stenosis could be truly severe or pseudosevere, and the severity of Aortic Stenosis has to be accurately evaluated for clinical decision-making. Nowadays, two types of interventions are available: surgical and transcatheter Aortic valve replacement, whereas conservative management should be considered as a palliative treatment in patients with proven severe Aortic Stenosis and symptoms or left ventricle dysfunction.
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Low-gradient Aortic Stenosis
European Heart Journal, 2016Co-Authors: Marie-annick Clavel, Julien Magne, Philippe PibarotAbstract:An important proportion of patients with Aortic Stenosis (AS) have a 'low-gradient' AS, i.e. a small Aortic valve area (AVA
Robert Donnino - One of the best experts on this subject based on the ideXlab platform.
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Gout and Progression of Aortic Stenosis.
The American journal of medicine, 2020Co-Authors: Andrew Adelsheimer, Craig Tenner, Alana Choy-shan, Virginia C. Pike, Binita Shah, Jeffrey D. Lorin, Nathaniel R. Smilowitz, Michael H. Pillinger, Robert DonninoAbstract:Abstract Background Patients with Aortic Stenosis are nearly twice as likely to have a diagnosis of gout compared with individuals without Aortic valve disease. Methods This retrospective study evaluated consecutive adults age ≥65 years with Aortic Stenosis between December 2012 and November 2016 who underwent at least 2 transthoracic echocardiograms (TTEs) separated by at least 1 year. Severe Aortic Stenosis was defined as any combination of an Aortic valve peak velocity ≥4.0 m/sec, mean gradient ≥40 mm Hg, Aortic valve area ≤1 cm2, or decrease in left ventricular ejection fraction as a result of Aortic Stenosis. Results Of the 699 study patients, gout was present in 73 patients (10%) and not found in 626 patients (90%). Median follow-up was 903 days [552-1302] for patients with gout and 915 days [601-1303] for patients without gout (P = 0.60). The presence of severe Aortic Stenosis on follow-up transthoracic echocardiogram was more frequent in patients with gout compared to those without gout (74% vs 54%, P = 0.001; hazard ratio [HR] 1.45 [1.09-1.93]), even among the 502 patients without severe Aortic Stenosis at baseline (63% vs 39%, P = 0.003; hazard ratio 1.43 [1.07-1.91]). Gout remained associated with the development of severe Aortic Stenosis after multivariable adjustment (adjusted hazard ratio [aHR] 1.46 [1.03-2.08], P = 0.03). The annualized reduction in Aortic valve area was numerically greater in the group with gout compared with the group without gout (−0.10 cm2/y [−0.18, −0.03] vs −0.08 cm2/y [−0.16, −0.01], P = 0.09); annualized change in peak velocity and mean gradient did not differ between groups. Conclusions Progression to severe Aortic Stenosis was more frequent in patients with gout compared with those without gout, supporting the hypothesis that gout is a risk factor for Aortic Stenosis.
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Association Between Gout and Aortic Stenosis
The American journal of medicine, 2016Co-Authors: Kevin Chang, Chio Yokose, Craig Tenner, Robert Donnino, Alana Choy-shan, Virginia C. Pike, Binita Shah, Jeffrey D. Lorin, Svetlana KrasnokutskyAbstract:BACKGROUND An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and Aortic Stenosis. METHODS We performed a retrospective case-control study. Aortic Stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have Aortic Stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and Aortic Stenosis diagnosis. RESULTS Among 1085 patients who underwent TTE, 112 Aortic Stenosis cases were identified. Cases and nonAortic Stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of Aortic Stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with Aortic Stenosis and gout, gout diagnosis preceded Aortic Stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of Aortic Stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16). CONCLUSIONS Aortic Stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of Aortic Stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of Aortic Stenosis are warranted and could have therapeutic implications.
Catherine M. Otto - One of the best experts on this subject based on the ideXlab platform.
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Indications for Aortic Valve Replacement in Aortic Stenosis
Journal of intensive care medicine, 2007Co-Authors: Karen K. Stout, Catherine M. OttoAbstract:Aortic Stenosis is a common condition, particularly in the elderly. The treatment is surgical, and any patient with symptomatic severe Aortic Stenosis should be considered for Aortic valve replacement. Aortic Stenosis causes an increase in afterload to the left ventricle, which when severe can lead to hemodynamic instability. Although the therapy of Aortic Stenosis is valve replacement, determining whether a patient has symptoms and accurately assessing the severity of Stenosis can be difficult. The management of patients with severe Aortic Stenosis in the intensive care unit setting can be very challenging, particularly when comorbid medical conditions make Aortic valve replacement difficult. This article reviews the diagnosis of Aortic Stenosis, methods of assessing symptoms and severity, and management of severe symptomatic Stenosis, particularly in the intensive care unit setting. Components of the history that suggest symptomatic Aortic Stenosis are presented. The role of physical examination is disc...
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Acquired Aortic Stenosis.
Expert review of cardiovascular therapy, 2004Co-Authors: Rosario V. Freeman, Gretchen Crittenden, Catherine M. OttoAbstract:Aortic Stenosis is the most commonly encountered valvular disease in the elderly, with approximately 2-3% of individuals over 65 years of age afflicted. The most common cause of acquired Aortic Stenosis is calcific degeneration, characterized by a slowly progressive, asymptomatic period which can last decades. Once symptomatic, the clinical manifestation of Aortic Stenosis is from functional obstruction of left ventricular outflow and the additional hemodynamic effects on the left ventricle and vasculature. With advances in echocardiography, individuals with Aortic Stenosis are increasingly diagnosed in the asymptomatic latent period. However, echocardiographic measures alone cannot identify clinically significant outflow obstruction as there is considerable overlap in hemodynamic severity between symptomatic and asymptomatic individuals. Current clinical guidelines predicate the timing of surgical valve replacement on the presence or absence of symptoms. Management for symptomatic, significant Stenosis is surgical valve replacement as there are no current medical therapies reliably proven to decrease Aortic Stenosis severity or improve long-term outcomes. However, recent retrospective studies have demonstrated an association between atherosclerotic disease risk factors, such as hyperlipidemia and Aortic Stenosis. Given these findings, there are now advocates for prospective primary prevention trials for Aortic Stenosis in patients with mild or moderate valvular disease. The following paper will discuss etiology, diagnostic evaluation and therapeutic options of acquired Aortic Stenosis. This review will discuss etiology, diagnostic evaluation, and therapeutic options of acquired Aortic Stenosis.
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Quantification of Valvular Aortic Stenosis
ACC Current Journal Review, 2003Co-Authors: Karen K. Stout, Catherine M. OttoAbstract:Valvular Aortic Stenosis is common in the elderly with mild valve thickening affecting 25% of adults over age 65 years and Stenosis affecting between 1–3% of elderly adults. Accurate diagnosis and quantitation of disease severity are important as valve replacement is needed when severe symptomatic obstruction is present. However, the symptoms of Aortic Stenosis are non-specific. Most patients present with decreased exercise tolerance or exertional dyspnea, while even the classical symptoms of angina, syncope and heart failure have many other possible causes, particularly in the elderly. This clinical problem is confounded by the high prevalence of systolic murmurs in the elderly. While most of these murmurs are due to Aortic sclerosis or a flow murmur, some are due to severe Aortic Stenosis.