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Diagnostic value of aortic valve resistance during dobutamine stress echocardiography in low-flow, low-gradient aortic stenosis
Session:
Sessão de Comunicações Orais 12 – Doença Valvular Cardíaca: diagnóstico, estratificação de risco e abordagem terapêutica
Speaker:
Mariana Sá
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.3 Valvular Heart Disease – Diagnostic Methods
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Raimundo Sá; Ana Rita Pereira; Adriana Silva; Paula Fazendas; Liliana Brochado; Tiago Lobão; Lourenço Aguiar; Inês Cruz; Ana Rita Almeida; Isabel João; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Background:</strong> In low-flow, low-gradient aortic stenosis (LFLG AS), standard dobutamine stress echocardiography (DSE) parameters may remain discordant, limiting diagnostic accuracy. Aortic valve resistance (AVR), integrating flow and transvalvular pressure, has been proposed as an adjunct index, but its added value during DSE is not well established.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Aim:</strong> To assess the diagnostic contribution of AVR compared with classical echocardiographic parameters in patients with LFLG AS undergoing DSE.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Patients with mean gradient <40 mmHg and AVA <1.0 cm² or <0.6 cm²/m² undergoing DSE (2014–2024) were included. AVR was calculated at rest and peak DSE. Thresholds followed published criteria: <120 dyn·s·cm<span style="font-family:"Cambria Math",serif">?</span>5 indicating pseudo-severe and >180 dyn·s·cm<span style="font-family:"Cambria Math",serif">?</span>5 indicating true-severe AS. Severity classification followed guideline DSE criteria. Diagnostic performance was evaluated using Pearson correlation, crosstabs, logistic regression, and ROC curves.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Results:</strong> Fifty-five patients were included (mean age 79.7±4.1 years; 87.7% male). Mean gradient, AVA and AVR were, respectively, 21.8±6.2 mmHg, 0.9±0.3 cm² and 174.4±79.3 dyn·s·cm<span style="font-family:"Cambria Math",serif">?</span>5 at baseline and 29.3±8.4 mmHg, 1.0±0.3 cm² and 167.2±77.2 dyn·s·cm<span style="font-family:"Cambria Math",serif">?</span>5 at peak. AVR strongly correlated with AVA at rest (r =–0.864) and peak (r =–0.777), p<0.001. Classical DSE criteria classified 61.5% as true-severe. AVR-based reclassification showed significant association with the classical classification (χ²=25.4, p<0.001; Cramer’s V=0.699). In univariate analysis, peak AVR (OR 1.12, 95%CI 1.0-1.2, p=0.003) and peak mean gradient (OR 1.12, 95%CI 1.0-1.3, p=0.001) were independent predictors of true-severe AS. In multivariate analysis, peak AVR remained independently associated (OR 1.1, 95%CI 1.0-1,2, p=0.003), while mean gradient lost significance (OR 1.0, 95% CI 0.8-1.3, p=0.761). ROC analysis confirmed superior diagnostic performance of peak AVR (AUC 0.980, p<0.001), with optimal cut-offs between 115–140 dyn·s·cm<span style="font-family:"Cambria Math",serif">?</span>5 achieving sensitivity ≥90% and specificity ≥80%. Peak mean gradient showed only moderate accuracy (AUC 0.749, p<0.001), with the best cut-off (32–33 mmHg) yielding sensitivity 47% and specificity 95%.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong> In our LFLG AS cohort, AVR during DSE strongly correlated with anatomic severity and outperformed classical DSE parameters in identifying true-severe stenosis. AVR appears to provide independent diagnostic value, but further studies are needed to confirm its utility.</span></span></span></p>
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