Integrating Echocardiographic Findings to Improve Diagnostic and Prognostic Assessments in Moderate Aortic Valve Stenosis: A Comprehensive Review
Abstract
Aortic valve stenosis (AS) is the most common valvular heart disease in developed countries, with its prevalence on the rise due to aging populations. While severe AS has long been recognized as high-risk, recent studies have shed light on the significant association between moderate AS and cardiovascular morbidity and mortality. Yet, the data are still inconclusive. With noninvasive multi-modality imaging techniques advancing rapidly, we now have more insight into the underlying biology of AS. Echocardiography continues to serve as the primary noninvasive imaging modality for diagnosing and grading AS. This comprehensive review delves into the role of echocardiography in diagnosing moderate AS and how the findings can support clinicians in making well-informed decisions that impact patients’ prognoses.
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3. Stassen J, Ewe SH, Butcher SC, Amanullah MR, Hirasawa K, Singh GK, Sin KYK, Ding ZP, Pio SM, Sia CH, Chew NWS, Kong WKF, Poh KK, Cohen DJ, Généreux P, Leon MB, Marsan NA, Delgado V, Bax JJ. Moderate aortic stenosis: importance of symptoms and left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2022;23:790-799.
4. Amanullah MR, Pio SM, Ng ACT, Sin KYK, Marsan NA, Ding ZP, Leon MB, Généreux P, Delgado V, Ewe SH, Bax JJ. Prognostic Implications of Associated Cardiac Abnormalities Detected on Echocardiography in Patients With Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2021;14:1724-1737.
5. Willner N, Prosperi-Porta G, Lau L, Nam Fu AY, Boczar K, Poulin A, Di Santo P, Unni RR, Visintini S, Ronksley PE, Chan KL, Beauchesne L, Burwash IG, Messika-Zeitoun D. Aortic Stenosis Progression: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023;16:314-328.
6. Baumgartner H Chair, Hung J Co-Chair, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, Lancellotti P, LeFevre M, Miller F Jr, Otto CM. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017;18:254-275.
7. Dweck MR, Loganath K, Bing R, Treibel TA, McCann GP, Newby DE, Leipsic J, Fraccaro C, Paolisso P, Cosyns B, Habib G, Cavalcante J, Donal E, Lancellotti P, Clavel MA, Otto CM, Pibarot P. Multi-modality imaging in aortic stenosis: an EACVI clinical consensus document. Eur Heart J Cardiovasc Imaging 2023;24:1430-1443.
8. Osnabrugge RL, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, Bogers AJ, Piazza N, Kappetein AP. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 2013;62:1002-1012.
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17. Théron A, Ternacle J, Pibarot P. Moderate aortic stenosis: The next frontier of transcatheter aortic valve implantation? Arch Cardiovasc Dis 2023;116:295-297.
18. Stassen J, Ewe SH, Singh GK, Butcher SC, Hirasawa K, Amanullah MR, Pio SM, Sin KYK, Ding ZP, Sia CH, Chew NWS, Kong WKF, Poh KK, Leon MB, Pibarot P, Delgado V, Marsan NA, Bax JJ. Prevalence and Prognostic Implications of Discordant Grading and Flow-Gradient Patterns in Moderate Aortic Stenosis. J Am Coll Cardiol 2022;80:666-676.
19. Maes F, Pierard S, de Meester C, Boulif J, Amzulescu M, Vancraeynest D, Pouleur AC, Pasquet A, Gerber B, Vanoverschelde JL. Impact of left ventricular outflow tract ellipticity on the grading of aortic stenosis in patients with normal ejection fraction. J Cardiovasc Magn Reson 2017;19:37.
20. Jainandunsing JS, Mahmood F, Matyal R, Shakil O, Hess PE, Lee J, Panzica PJ, Khabbaz KR. Impact of three-dimensional echocardiography on classification of the severity of aortic stenosis. Ann Thorac Surg 2013;96:1343-1348.
21. Leye M, Brochet E, Lepage L, Cueff C, Boutron I, Detaint D, Hyafil F, Iung B, Vahanian A, Messika-Zeitoun D. Size-adjusted left ventricular outflow tract diameter reference values: a safeguard for the evaluation of the severity of aortic stenosis. J Am Soc Echocardiogr 2009;22:445-51.
22. Benfari G, Gori AM, Rossi A, Papesso B, Vassanelli C, Zito GB, Nistri S. Feasibility and relevance of right parasternal view for assessing severity and rate of progression of aortic valve stenosis in primary care. Int J Cardiol 2017;240:446-451.
23. Benfari G, Mantovani F, Romero-Brufau S, Setti M, Rossi A, Ribichini FL, Nistri S, Clavel MA. The right parasternal window: when Doppler-beam alignment may be life-saving in patients with aortic valve stenosis. J Cardiovasc Med (Hagerstown) 2020;21:831-834.
24. Shimamura T, Izumo M, Sato Y, Shiokawa N, Uenomachi N, Miyauchi M, Miyamoto J, Kikuchi H, Shinoda J, Okamura T, Akashi YJ. Additive value of the right parasternal view for the assessment of aortic stenosis. Echocardiography 2022;39:1338-1343.
25. Pio SM, Amanullah MR, Butcher SC, Sin KY, Ajmone Marsan N, Pibarot P, Van Mieghem NM, Ding ZP, Généreux P, Leon MB, Ewe SH, Delgado V, Bax JJ. Discordant severity criteria in patients with moderate aortic stenosis: prognostic implications. Open Heart 2021;8:e001639.
26. Rizzello V. Moderate gradient severe aortic stenosis: diagnosis, prognosis and therapy. Eur Heart J Suppl 2021;23(Suppl E):E133-E137.
27. Barbieri A, Antonini-Canterin F, Pepi M, Monte IP, Trocino G, Barchitta A, Ciampi Q, Cresti A, Miceli S, Petrella L, Benedetto F, Zito C, Benfari G, Bursi F, Malagoli A, Bartolacelli Y, Mantovani F, Clavel MA. Discordant Echocardiographic Grading in Low Gradient Aortic Stenosis (DEGAS Study) From the Italian Society of Echocardiography and Cardiovascular Imaging Research Network: Rationale and Study Design. J Cardiovasc Echogr 2020;30:52-61.
28. Annabi MS, Touboul E, Dahou A, Burwash IG, Bergler-Klein J, Enriquez-Sarano M, Orwat S, Baumgartner H, Mascherbauer J, Mundigler G, Cavalcante JL, Larose É, Pibarot P, Clavel MA. Dobutamine Stress Echocardiography for Management of Low-Flow, Low-Gradient Aortic Stenosis. J Am Coll Cardiol 2018;71:475-485.
29. Clavel MA, Magne J, Pibarot P. Low-gradient aortic stenosis. Eur Heart J 2016;37:2645-2657.
30. Pibarot P, Messika-Zeitoun D, Ben-Yehuda O, Hahn RT, Burwash IG, Van Mieghem NM, Spitzer E, Leon MB, Bax J, Otto CM. Moderate Aortic Stenosis and Heart Failure With Reduced Ejection Fraction: Can Imaging Guide Us to Therapy? JACC Cardiovasc Imaging 2019;12:172-184.
31. Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, Duval X, Iung B, Enriquez-Sarano M, Vahanian A, Messika-Zeitoun D. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart 2011;97:721-726.
32. Messika-Zeitoun D, Aubry MC, Detaint D, Bielak LF, Peyser PA, Sheedy PF, Turner ST, Breen JF, Scott C, Tajik AJ, Enriquez-Sarano M. Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography. Circulation 2004;110:356-362.
33. Pawade T, Clavel MA, Tribouilloy C, Dreyfus J, Mathieu T, Tastet L, Renard C, Gun M, Jenkins WSA, Macron L, Sechrist JW, Lacomis JM, Nguyen V, Galian Gay L, Cuéllar Calabria H, Ntalas I, Cartlidge TRG, Prendergast B, Rajani R, Evangelista A, Cavalcante JL, Newby DE, Pibarot P, Messika Zeitoun D, Dweck MR. Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis. Circ Cardiovasc Imaging 2018;11:e007146.
34. Stewart S, Playford D, Scalia GM, Currie P, Celermajer DS, Prior D, Codde J, Strange G; NEDA Investigators. Ejection fraction and mortality: a nationwide register-based cohort study of 499 153 women and men. Eur J Heart Fail 2021;23:406-416.
35. Ito S, Miranda WR, Nkomo VT, Boler AN, Pislaru SV, Pellikka PA, Crusan DJ, Lewis BR, Nishimura RA, Oh JK. Prognostic Risk Stratification of Patients with Moderate Aortic Stenosis. J Am Soc Echocardiogr 2021;34:248-256.
36. Saeed S, Gu H, Rajani R, Chowienczyk P, Chambers JB. First phase ejection fraction in aortic stenosis: A useful new measure of early left ventricular systolic dysfunction. J Clin Ultrasound 2021;49:932-935.
37. Delesalle G, Bohbot Y, Rusinaru D, Delpierre Q, Maréchaux S, Tribouilloy C. Characteristics and Prognosis of Patients With Moderate Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. J Am Heart Assoc 2019;8:e011036.
38. Stassen J, Pio SM, Ewe SH, Singh GK, Hirasawa K, Butcher SC, Cohen DJ, Généreux P, Leon MB, Marsan NA, Delgado V, Bax JJ. Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis. J Am Soc Echocardiogr 2022;35:791-800.e4.
39. Zhu D, Ito S, Miranda WR, Nkomo VT, Pislaru SV, Villarraga HR, Pellikka PA, Crusan DJ, Oh JK. Left Ventricular Global Longitudinal Strain Is Associated With Long-Term Outcomes in Moderate Aortic Stenosis. Circ Cardiovasc Imaging 2020;13:e009958.
40. Saeed S, Scalise F, Chambers JB, Mancia G. Hypertension in aortic stenosis: a focused review and recommendations for clinical practice. J Hypertens 2020;38:1211-1219.
41. Kusunose K. Is diastolic dysfunction a red flag sign in moderate aortic stenosis? Heart 2022;108:1340-1341.
42. Stassen J, Ewe SH, Butcher SC, Amanullah MR, Mertens BJ, Hirasawa K, Singh GK, Sin KY, Ding ZP, Pio SM, Sia CH, Chew N, Kong W, Poh KK, Cohen D, Généreux P, Leon MB, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis. Heart 2022;108:1401-1407.
43. Stöbe S, Kandels J, Metze M, Tayal B, Laufs U, Hagendorff A. Left ventricular hypertrophy, diastolic dysfunction and right ventricular load predict outcome in moderate aortic stenosis. Front Cardiovasc Med 2023;9:1101493.
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2. Stassen J, Ewe SH, Pio SM, Pibarot P, Redfors B, Leipsic J, Genereux P, Van Mieghem NM, Kuneman JH, Makkar R, Hahn RT, Playford D, Marsan NA, Delgado V, Ben-Yehuda O, Leon MB, Bax JJ. Managing Patients With Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2023;16:837-855.
3. Stassen J, Ewe SH, Butcher SC, Amanullah MR, Hirasawa K, Singh GK, Sin KYK, Ding ZP, Pio SM, Sia CH, Chew NWS, Kong WKF, Poh KK, Cohen DJ, Généreux P, Leon MB, Marsan NA, Delgado V, Bax JJ. Moderate aortic stenosis: importance of symptoms and left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2022;23:790-799.
4. Amanullah MR, Pio SM, Ng ACT, Sin KYK, Marsan NA, Ding ZP, Leon MB, Généreux P, Delgado V, Ewe SH, Bax JJ. Prognostic Implications of Associated Cardiac Abnormalities Detected on Echocardiography in Patients With Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2021;14:1724-1737.
5. Willner N, Prosperi-Porta G, Lau L, Nam Fu AY, Boczar K, Poulin A, Di Santo P, Unni RR, Visintini S, Ronksley PE, Chan KL, Beauchesne L, Burwash IG, Messika-Zeitoun D. Aortic Stenosis Progression: A Systematic Review and Meta-Analysis. JACC Cardiovasc Imaging 2023;16:314-328.
6. Baumgartner H Chair, Hung J Co-Chair, Bermejo J, Chambers JB, Edvardsen T, Goldstein S, Lancellotti P, LeFevre M, Miller F Jr, Otto CM. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2017;18:254-275.
7. Dweck MR, Loganath K, Bing R, Treibel TA, McCann GP, Newby DE, Leipsic J, Fraccaro C, Paolisso P, Cosyns B, Habib G, Cavalcante J, Donal E, Lancellotti P, Clavel MA, Otto CM, Pibarot P. Multi-modality imaging in aortic stenosis: an EACVI clinical consensus document. Eur Heart J Cardiovasc Imaging 2023;24:1430-1443.
8. Osnabrugge RL, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, Bogers AJ, Piazza N, Kappetein AP. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 2013;62:1002-1012.
9. Coffey S, Cairns BJ, Iung B. The modern epidemiology of heart valve disease. Heart 2016;102:75-85.
10. Eveborn GW, Schirmer H, Heggelund G, Lunde P, Rasmussen K. The evolving epidemiology of valvular aortic stenosis. the Tromsø study. Heart 2013;99:396-400.
11. Bohbot Y, Coisne A, Altes A, Levy F, Di Lena C, Aghezzaf S, Maréchaux S, Rusinaru D, Tribouilloy C. Is "moderate" aortic stenosis still the right name? A review of the literature. Arch Cardiovasc Dis 2023;116:411-418.
12. Mann TD, Loewenstein I, Ben Assa E, Topilsky Y. Natural History of Moderate Aortic Stenosis with Preserved and Low Ejection Fraction. J Am Soc Echocardiogr 2021;34:735-743.
13. Strange G, Stewart S, Celermajer D, Prior D, Scalia GM, Marwick T, Ilton M, Joseph M, Codde J, Playford D; National Echocardiography Database of Australia contributing sites. Poor Long-Term Survival in Patients With Moderate Aortic Stenosis. J Am Coll Cardiol 2019;74:1851-1863.
14. Ring L, Shah BN, Bhattacharyya S, Harkness A, Belham M, Oxborough D, Pearce K, Rana BS, Augustine DX, Robinson S, Tribouilloy C. Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography. Echo Res Pract 2021;8:G19-G59.
15. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed) 2022;75:524.
16. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e35-e71.
17. Théron A, Ternacle J, Pibarot P. Moderate aortic stenosis: The next frontier of transcatheter aortic valve implantation? Arch Cardiovasc Dis 2023;116:295-297.
18. Stassen J, Ewe SH, Singh GK, Butcher SC, Hirasawa K, Amanullah MR, Pio SM, Sin KYK, Ding ZP, Sia CH, Chew NWS, Kong WKF, Poh KK, Leon MB, Pibarot P, Delgado V, Marsan NA, Bax JJ. Prevalence and Prognostic Implications of Discordant Grading and Flow-Gradient Patterns in Moderate Aortic Stenosis. J Am Coll Cardiol 2022;80:666-676.
19. Maes F, Pierard S, de Meester C, Boulif J, Amzulescu M, Vancraeynest D, Pouleur AC, Pasquet A, Gerber B, Vanoverschelde JL. Impact of left ventricular outflow tract ellipticity on the grading of aortic stenosis in patients with normal ejection fraction. J Cardiovasc Magn Reson 2017;19:37.
20. Jainandunsing JS, Mahmood F, Matyal R, Shakil O, Hess PE, Lee J, Panzica PJ, Khabbaz KR. Impact of three-dimensional echocardiography on classification of the severity of aortic stenosis. Ann Thorac Surg 2013;96:1343-1348.
21. Leye M, Brochet E, Lepage L, Cueff C, Boutron I, Detaint D, Hyafil F, Iung B, Vahanian A, Messika-Zeitoun D. Size-adjusted left ventricular outflow tract diameter reference values: a safeguard for the evaluation of the severity of aortic stenosis. J Am Soc Echocardiogr 2009;22:445-51.
22. Benfari G, Gori AM, Rossi A, Papesso B, Vassanelli C, Zito GB, Nistri S. Feasibility and relevance of right parasternal view for assessing severity and rate of progression of aortic valve stenosis in primary care. Int J Cardiol 2017;240:446-451.
23. Benfari G, Mantovani F, Romero-Brufau S, Setti M, Rossi A, Ribichini FL, Nistri S, Clavel MA. The right parasternal window: when Doppler-beam alignment may be life-saving in patients with aortic valve stenosis. J Cardiovasc Med (Hagerstown) 2020;21:831-834.
24. Shimamura T, Izumo M, Sato Y, Shiokawa N, Uenomachi N, Miyauchi M, Miyamoto J, Kikuchi H, Shinoda J, Okamura T, Akashi YJ. Additive value of the right parasternal view for the assessment of aortic stenosis. Echocardiography 2022;39:1338-1343.
25. Pio SM, Amanullah MR, Butcher SC, Sin KY, Ajmone Marsan N, Pibarot P, Van Mieghem NM, Ding ZP, Généreux P, Leon MB, Ewe SH, Delgado V, Bax JJ. Discordant severity criteria in patients with moderate aortic stenosis: prognostic implications. Open Heart 2021;8:e001639.
26. Rizzello V. Moderate gradient severe aortic stenosis: diagnosis, prognosis and therapy. Eur Heart J Suppl 2021;23(Suppl E):E133-E137.
27. Barbieri A, Antonini-Canterin F, Pepi M, Monte IP, Trocino G, Barchitta A, Ciampi Q, Cresti A, Miceli S, Petrella L, Benedetto F, Zito C, Benfari G, Bursi F, Malagoli A, Bartolacelli Y, Mantovani F, Clavel MA. Discordant Echocardiographic Grading in Low Gradient Aortic Stenosis (DEGAS Study) From the Italian Society of Echocardiography and Cardiovascular Imaging Research Network: Rationale and Study Design. J Cardiovasc Echogr 2020;30:52-61.
28. Annabi MS, Touboul E, Dahou A, Burwash IG, Bergler-Klein J, Enriquez-Sarano M, Orwat S, Baumgartner H, Mascherbauer J, Mundigler G, Cavalcante JL, Larose É, Pibarot P, Clavel MA. Dobutamine Stress Echocardiography for Management of Low-Flow, Low-Gradient Aortic Stenosis. J Am Coll Cardiol 2018;71:475-485.
29. Clavel MA, Magne J, Pibarot P. Low-gradient aortic stenosis. Eur Heart J 2016;37:2645-2657.
30. Pibarot P, Messika-Zeitoun D, Ben-Yehuda O, Hahn RT, Burwash IG, Van Mieghem NM, Spitzer E, Leon MB, Bax J, Otto CM. Moderate Aortic Stenosis and Heart Failure With Reduced Ejection Fraction: Can Imaging Guide Us to Therapy? JACC Cardiovasc Imaging 2019;12:172-184.
31. Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, Duval X, Iung B, Enriquez-Sarano M, Vahanian A, Messika-Zeitoun D. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart 2011;97:721-726.
32. Messika-Zeitoun D, Aubry MC, Detaint D, Bielak LF, Peyser PA, Sheedy PF, Turner ST, Breen JF, Scott C, Tajik AJ, Enriquez-Sarano M. Evaluation and clinical implications of aortic valve calcification measured by electron-beam computed tomography. Circulation 2004;110:356-362.
33. Pawade T, Clavel MA, Tribouilloy C, Dreyfus J, Mathieu T, Tastet L, Renard C, Gun M, Jenkins WSA, Macron L, Sechrist JW, Lacomis JM, Nguyen V, Galian Gay L, Cuéllar Calabria H, Ntalas I, Cartlidge TRG, Prendergast B, Rajani R, Evangelista A, Cavalcante JL, Newby DE, Pibarot P, Messika Zeitoun D, Dweck MR. Computed Tomography Aortic Valve Calcium Scoring in Patients With Aortic Stenosis. Circ Cardiovasc Imaging 2018;11:e007146.
34. Stewart S, Playford D, Scalia GM, Currie P, Celermajer DS, Prior D, Codde J, Strange G; NEDA Investigators. Ejection fraction and mortality: a nationwide register-based cohort study of 499 153 women and men. Eur J Heart Fail 2021;23:406-416.
35. Ito S, Miranda WR, Nkomo VT, Boler AN, Pislaru SV, Pellikka PA, Crusan DJ, Lewis BR, Nishimura RA, Oh JK. Prognostic Risk Stratification of Patients with Moderate Aortic Stenosis. J Am Soc Echocardiogr 2021;34:248-256.
36. Saeed S, Gu H, Rajani R, Chowienczyk P, Chambers JB. First phase ejection fraction in aortic stenosis: A useful new measure of early left ventricular systolic dysfunction. J Clin Ultrasound 2021;49:932-935.
37. Delesalle G, Bohbot Y, Rusinaru D, Delpierre Q, Maréchaux S, Tribouilloy C. Characteristics and Prognosis of Patients With Moderate Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. J Am Heart Assoc 2019;8:e011036.
38. Stassen J, Pio SM, Ewe SH, Singh GK, Hirasawa K, Butcher SC, Cohen DJ, Généreux P, Leon MB, Marsan NA, Delgado V, Bax JJ. Left Ventricular Global Longitudinal Strain in Patients with Moderate Aortic Stenosis. J Am Soc Echocardiogr 2022;35:791-800.e4.
39. Zhu D, Ito S, Miranda WR, Nkomo VT, Pislaru SV, Villarraga HR, Pellikka PA, Crusan DJ, Oh JK. Left Ventricular Global Longitudinal Strain Is Associated With Long-Term Outcomes in Moderate Aortic Stenosis. Circ Cardiovasc Imaging 2020;13:e009958.
40. Saeed S, Scalise F, Chambers JB, Mancia G. Hypertension in aortic stenosis: a focused review and recommendations for clinical practice. J Hypertens 2020;38:1211-1219.
41. Kusunose K. Is diastolic dysfunction a red flag sign in moderate aortic stenosis? Heart 2022;108:1340-1341.
42. Stassen J, Ewe SH, Butcher SC, Amanullah MR, Mertens BJ, Hirasawa K, Singh GK, Sin KY, Ding ZP, Pio SM, Sia CH, Chew N, Kong W, Poh KK, Cohen D, Généreux P, Leon MB, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis. Heart 2022;108:1401-1407.
43. Stöbe S, Kandels J, Metze M, Tayal B, Laufs U, Hagendorff A. Left ventricular hypertrophy, diastolic dysfunction and right ventricular load predict outcome in moderate aortic stenosis. Front Cardiovasc Med 2023;9:1101493.
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| Files | ||
| Issue | Vol 19 No 3 (2024): J Teh Univ Heart Ctr | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v19i3.16858 | |
| Keywords | ||
| Aortic stenosis Echocardiography Diagnosis Review | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sahebjam M, Shafiee A. Integrating Echocardiographic Findings to Improve Diagnostic and Prognostic Assessments in Moderate Aortic Valve Stenosis: A Comprehensive Review. J Tehran Heart Cent. 2024;19(3):153-161.
