Longitudinal Assessment of the Doppler-Estimated Maximum Gradient in Patients With Congenital Valvar Aortic Stenosis Pre- and Post-Balloon Valvuloplasty
Aortic stenosis has been reported to manifest a slow rate of progression in mild disease, with a greater likelihood of progression in patients with moderate-severe disease. The natural history of the Doppler-estimated maximum gradient (DEMG) in patients after balloon aortic valvuloplasty (BAVP) has...
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| Veröffentlicht in: | Circulation. Cardiovascular imaging 2018-03, Vol.11 (3), p.e006708-e006708 |
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| container_title | Circulation. Cardiovascular imaging |
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| creator | Kuebler, Joseph D Shivapour, Jill Yaroglu Kazanci, Selcen Gauvreau, Kimberlee Colan, Steven D McElhinney, Doff B Brown, David W |
| description | Aortic stenosis has been reported to manifest a slow rate of progression in mild disease, with a greater likelihood of progression in patients with moderate-severe disease. The natural history of the Doppler-estimated maximum gradient (DEMG) in patients after balloon aortic valvuloplasty (BAVP) has not previously been studied on a large scale.
A retrospective review was performed of 360 patients from 1984 to 2012 with aortic stenosis, providing a total of 2059 echocardiograms both before and after BAVP. Patients were excluded if they had an intervention within the first 30 days of life. The relationships between the aortic stenosis DEMG and several predictors (age at initial study, body surface area, valve morphology, and initial DEMG) were explored using linear mixed effect models. Patients with a unicommissural aortic valve had a significantly higher rate of progression compared with those with a bicommissural aortic valve (0.81 and 0.45 mm Hg/year; |
| doi_str_mv | 10.1161/CIRCIMAGING.117.006708 |
| format | Article |
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A retrospective review was performed of 360 patients from 1984 to 2012 with aortic stenosis, providing a total of 2059 echocardiograms both before and after BAVP. Patients were excluded if they had an intervention within the first 30 days of life. The relationships between the aortic stenosis DEMG and several predictors (age at initial study, body surface area, valve morphology, and initial DEMG) were explored using linear mixed effect models. Patients with a unicommissural aortic valve had a significantly higher rate of progression compared with those with a bicommissural aortic valve (0.81 and 0.45 mm Hg/year;
<0.001). The median rate of progression in the post-BAVP group was significantly lower than the median pre-BAVP rate of progression (n=34; pre-BAVP 3.97 [1.69-8.7] mm Hg/year; post-BAVP 0.40 [-1.80 to 3.88] mm Hg/year;
<0.008). When adjusted for body surface area, there was no significant increase in the DEMG (-0.03 mm Hg/m
per year;
<0.001).
There is a statistically significant increase in the DEMG over time in patients with aortic stenosis. After balloon dilation, the DEMG rate of change is reduced compared with that pre-dilation. Given the effect of body surface area on DEMG progression, more frequent observation should be made during periods of rapid somatic growth.</description><identifier>ISSN: 1941-9651</identifier><identifier>EISSN: 1942-0080</identifier><identifier>DOI: 10.1161/CIRCIMAGING.117.006708</identifier><identifier>PMID: 29555832</identifier><language>eng</language><publisher>United States</publisher><ispartof>Circulation. Cardiovascular imaging, 2018-03, Vol.11 (3), p.e006708-e006708</ispartof><rights>2018 American Heart Association, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c359t-7c7d09dcfd04aa16893174f0109a8958d5bb3866228fb0e9a5ccb229d77ac55b3</citedby><cites>FETCH-LOGICAL-c359t-7c7d09dcfd04aa16893174f0109a8958d5bb3866228fb0e9a5ccb229d77ac55b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29555832$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kuebler, Joseph D</creatorcontrib><creatorcontrib>Shivapour, Jill</creatorcontrib><creatorcontrib>Yaroglu Kazanci, Selcen</creatorcontrib><creatorcontrib>Gauvreau, Kimberlee</creatorcontrib><creatorcontrib>Colan, Steven D</creatorcontrib><creatorcontrib>McElhinney, Doff B</creatorcontrib><creatorcontrib>Brown, David W</creatorcontrib><title>Longitudinal Assessment of the Doppler-Estimated Maximum Gradient in Patients With Congenital Valvar Aortic Stenosis Pre- and Post-Balloon Valvuloplasty</title><title>Circulation. Cardiovascular imaging</title><addtitle>Circ Cardiovasc Imaging</addtitle><description>Aortic stenosis has been reported to manifest a slow rate of progression in mild disease, with a greater likelihood of progression in patients with moderate-severe disease. The natural history of the Doppler-estimated maximum gradient (DEMG) in patients after balloon aortic valvuloplasty (BAVP) has not previously been studied on a large scale.
A retrospective review was performed of 360 patients from 1984 to 2012 with aortic stenosis, providing a total of 2059 echocardiograms both before and after BAVP. Patients were excluded if they had an intervention within the first 30 days of life. The relationships between the aortic stenosis DEMG and several predictors (age at initial study, body surface area, valve morphology, and initial DEMG) were explored using linear mixed effect models. Patients with a unicommissural aortic valve had a significantly higher rate of progression compared with those with a bicommissural aortic valve (0.81 and 0.45 mm Hg/year;
<0.001). The median rate of progression in the post-BAVP group was significantly lower than the median pre-BAVP rate of progression (n=34; pre-BAVP 3.97 [1.69-8.7] mm Hg/year; post-BAVP 0.40 [-1.80 to 3.88] mm Hg/year;
<0.008). When adjusted for body surface area, there was no significant increase in the DEMG (-0.03 mm Hg/m
per year;
<0.001).
There is a statistically significant increase in the DEMG over time in patients with aortic stenosis. After balloon dilation, the DEMG rate of change is reduced compared with that pre-dilation. Given the effect of body surface area on DEMG progression, more frequent observation should be made during periods of rapid somatic growth.</description><issn>1941-9651</issn><issn>1942-0080</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNpNkd1u1DAQhS0EoqXwCpUvuUmxk3VsXy6hbFfaworfy8ixHWrk2KnHQe2b8Lh4uwVxNUdH35yR5iB0TskFpS19020_ddvr9Wb7YVMMfkFIy4l4gk6pXNUVIYI8fdC0ki2jJ-gFwM_CNISJ5-iklowx0dSn6Pcuhh8uL8YF5fEawAJMNmQcR5xvLH4X59nbVF1CdpPK1uBrdeemZcKbpIw7kC7gvcoHCfi7yze4K5E2uFwCvyn_SyW8jik7jT9nGyI4wPtkK6yCwfsIuXqrvI8xPMCLj7NXkO9fomej8mBfPc4z9PX95Zfuqtp93Gy79a7SDZO54pobIo0eDVkpRVshG8pXI6FEKiGZMGwYGtG2dS3GgVipmNZDXUvDudKMDc0Zen3MnVO8XSzkfnKgrfcq2LhAXxNaPiVaTgvaHlGdIkCyYz-n8pR031PSH1rp_2ulGLw_tlIWzx9vLMNkzb-1vzU0fwCS44xS</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Kuebler, Joseph D</creator><creator>Shivapour, Jill</creator><creator>Yaroglu Kazanci, Selcen</creator><creator>Gauvreau, Kimberlee</creator><creator>Colan, Steven D</creator><creator>McElhinney, Doff B</creator><creator>Brown, David W</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201803</creationdate><title>Longitudinal Assessment of the Doppler-Estimated Maximum Gradient in Patients With Congenital Valvar Aortic Stenosis Pre- and Post-Balloon Valvuloplasty</title><author>Kuebler, Joseph D ; Shivapour, Jill ; Yaroglu Kazanci, Selcen ; Gauvreau, Kimberlee ; Colan, Steven D ; McElhinney, Doff B ; Brown, David W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c359t-7c7d09dcfd04aa16893174f0109a8958d5bb3866228fb0e9a5ccb229d77ac55b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kuebler, Joseph D</creatorcontrib><creatorcontrib>Shivapour, Jill</creatorcontrib><creatorcontrib>Yaroglu Kazanci, Selcen</creatorcontrib><creatorcontrib>Gauvreau, Kimberlee</creatorcontrib><creatorcontrib>Colan, Steven D</creatorcontrib><creatorcontrib>McElhinney, Doff B</creatorcontrib><creatorcontrib>Brown, David W</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation. Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kuebler, Joseph D</au><au>Shivapour, Jill</au><au>Yaroglu Kazanci, Selcen</au><au>Gauvreau, Kimberlee</au><au>Colan, Steven D</au><au>McElhinney, Doff B</au><au>Brown, David W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Longitudinal Assessment of the Doppler-Estimated Maximum Gradient in Patients With Congenital Valvar Aortic Stenosis Pre- and Post-Balloon Valvuloplasty</atitle><jtitle>Circulation. Cardiovascular imaging</jtitle><addtitle>Circ Cardiovasc Imaging</addtitle><date>2018-03</date><risdate>2018</risdate><volume>11</volume><issue>3</issue><spage>e006708</spage><epage>e006708</epage><pages>e006708-e006708</pages><issn>1941-9651</issn><eissn>1942-0080</eissn><abstract>Aortic stenosis has been reported to manifest a slow rate of progression in mild disease, with a greater likelihood of progression in patients with moderate-severe disease. The natural history of the Doppler-estimated maximum gradient (DEMG) in patients after balloon aortic valvuloplasty (BAVP) has not previously been studied on a large scale.
A retrospective review was performed of 360 patients from 1984 to 2012 with aortic stenosis, providing a total of 2059 echocardiograms both before and after BAVP. Patients were excluded if they had an intervention within the first 30 days of life. The relationships between the aortic stenosis DEMG and several predictors (age at initial study, body surface area, valve morphology, and initial DEMG) were explored using linear mixed effect models. Patients with a unicommissural aortic valve had a significantly higher rate of progression compared with those with a bicommissural aortic valve (0.81 and 0.45 mm Hg/year;
<0.001). The median rate of progression in the post-BAVP group was significantly lower than the median pre-BAVP rate of progression (n=34; pre-BAVP 3.97 [1.69-8.7] mm Hg/year; post-BAVP 0.40 [-1.80 to 3.88] mm Hg/year;
<0.008). When adjusted for body surface area, there was no significant increase in the DEMG (-0.03 mm Hg/m
per year;
<0.001).
There is a statistically significant increase in the DEMG over time in patients with aortic stenosis. After balloon dilation, the DEMG rate of change is reduced compared with that pre-dilation. Given the effect of body surface area on DEMG progression, more frequent observation should be made during periods of rapid somatic growth.</abstract><cop>United States</cop><pmid>29555832</pmid><doi>10.1161/CIRCIMAGING.117.006708</doi><oa>free_for_read</oa></addata></record> |
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| issn | 1941-9651 1942-0080 |
| language | eng |
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| source | EZB Electronic Journals Library; American Heart Association |
| title | Longitudinal Assessment of the Doppler-Estimated Maximum Gradient in Patients With Congenital Valvar Aortic Stenosis Pre- and Post-Balloon Valvuloplasty |
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