Energy Loss Index in Aortic Stenosis

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Presentation transcript:

Energy Loss Index in Aortic Stenosis by Philippe Pibarot, Damien Garcia, and Jean G. Dumesnil Circulation Volume 127(10):1101-1104 March 12, 2013 Copyright © American Heart Association, Inc. All rights reserved.

The phenomenon of pressure recovery in aortic stenosis. The phenomenon of pressure recovery in aortic stenosis. Schematic representation of flow and blood pressure across the left ventricular outflow tract (PLVOT), aortic valve, and ascending aorta (AA) during systole in 2 theoretical patients having the same stroke volume (80 mL) and valve effective orifice area (EOA; 0.9 cm2) but different sizes of ascending aorta (2.0 cm diameter in patient 1 vs 4.0 cm in patient 2). The maximum pressure gradient recorded at vena contracta (ΔPmax; ie, the mean gradient measured by Doppler) is the same in the 2 patients, but patient 1 with the small aorta has a large amount of pressure recovery (PR) downstream of the valve, whereas patient 2 has minimal pressure recovery. Consequently, the net “irreversible” gradient (ΔPnet; ie, measured by catheter) and thus the left ventricular systolic pressure are significantly higher in patient 2 than in patient 1. LVOT indicates left ventricular outflow tract. Philippe Pibarot et al. Circulation. 2013;127:1101-1104 Copyright © American Heart Association, Inc. All rights reserved.

Relationship between energy loss index (ELI) and indexed aortic valve area (AVAI) for different aorta sizes. Relationship between energy loss index (ELI) and indexed aortic valve area (AVAI) for different aorta sizes. The calculation of ELI becomes more relevant in patients with an ascending aorta diameter (∅) <3.0 cm and/or with an AVAI >0.5 cm2/m2. *Best cut point of ELI to predict outcomes over an 8-month follow-up in the study by Garcia et al.3 **Cut point of ELI used for reclassification of stenosis severity in the previous study by Bahlmann et al.7 ***Best cut point of ELI to predict outcomes over a 4-year follow-up in the present study.4 The black dashed line is the identity line. Philippe Pibarot et al. Circulation. 2013;127:1101-1104 Copyright © American Heart Association, Inc. All rights reserved.