Echocardiography  
Favaloro Foundation. Buenos Aires, Argentina.

JACC Cardiovascular Imaging has recently published a retrospective analysis including severe aortic stenosis patients (< 1 cm²), with low gradient (mean aortic gradient

Patients that had undergone dobutamine stress echocardiography (DSE) to distinguish pseudo aortic stenosis (n=49) were selected. These results were used to determine flow reserve (FR). The study aims to evaluate the efficacy of this approach in assessing intervention risk and long term evolution in patients with severe aortic stenosis, low gradient and ventricular function deterioration, with either reduced or normal ejection fraction, undergoing TAVR.

Flow reserve was defined as a 20% increase in stroke volume index (SVI) from rest to peak dobutamine infusion, compared to baseline echocardiography. After TAVR, patients were followed up to assess mortality.

The analysis included 49 elderly patients (80±8), 70% men, 88% white.  Prosthesis of choice was SAPIEN transcatheter heart valve from Edwards Lifescience. Approaches of choice were transfemoral (60%) and transapical (40%). 

Mean ejection fraction was 38±14%. Most patients (70%) presented