Indicator Mild Moderate Severe

Size: px
Start display at page:

Download "Indicator Mild Moderate Severe"

Transcription

1 Indicator Mild Moderate Severe Jet velocity (m/s) Mean gradient (mmhg) < Valve area (cm 2 ) 1.0 Valve area index (cm 2 /m 2 ) 0.6 1

2 Abnormal AV with Reduced Systolic Opening Severe AS V max 4 m/sec P mean 40 mmhg V max m/sec P mean mmhg Symptomatic (stage D1) Asymptomatic (stage C) Symptomatic Asymptomatic LVEF < 50% (stage C2) Other cardiac surgery Vmax 5 m/sec P mean 60mmHg Low surgical risk LVEF<50% Yes DSE with AVA 1 cm 2 and V max 4m/sec (stage D2) No AVA 1 cm 2 and LVEF 50% (stage D3*) Other cardiac surgery Abnormal ETT V max 0.3 m/s/y Low surgical risk AS likely cause of symptoms AVR (Class I) AVR (Class IIa) AVR (Class IIb) AVR (Class IIa) 2

3 Case. Asymptomatic Severe AS Case. Asymptomatic Severe AS AV Vmax = 4.6 m/sec AV Vmax = 5.5 m/sec 3

4 Case. Asymptomatic Severe AS LVOT diameter 2.1 cm LVOT TVI 21 cm Vmax = 5.5 m/sec AV TVI 154 cm Comparison of Early Surgery versus Conventional Treatment in Asymptomatic Very Severe Aortic Stenosis Duk-Hyun Kang, Sung-Ji Park*, Ji Hye Rim, Dae-Hee Kim, Jong-Min Song, Kee-Joon Choi, Seung Woo Park*, Jae-Kwan Song, Jae-Won Lee, Pyo-Won Park* Division of Cardiology, Cardiac Surgery Asan Medical Center, Samsung Medical Center* Seoul, South Korea Kang DH, et al. Circulation 2010;121:1502 4

5 Survival Free of Cardiac Death OP versus CONV group Cardiac mortality free survival (%) P<0.001 OP 6-year survival rate 100% CONV 6-year survival rate 76±5% OP CONV years No at Risk OP CONV Abnormal AV with Reduced Systolic Opening Severe AS V max 4 m/sec P mean 40 mmhg V max m/sec P mean mmhg Symptomatic (stage D1) Asymptomatic (stage C) Symptomatic Asymptomatic LVEF < 50% (stage C2) Other cardiac surgery Vmax 5 m/sec P mean 60mmHg Low surgical risk LVEF<50% Yes DSE with AVA 1 cm 2 and V max 4m/sec (stage D2) No AVA 1 cm 2 and LVEF 50% (stage D3*) Other cardiac surgery Abnormal ETT V max 0.3 m/s/y Low surgical risk AS likely cause of symptoms AVR (Class I) AVR (Class IIa) AVR (Class IIb) AVR (Class IIa) 5

6 Indicator Mild Moderate Severe Jet velocity (m/s) < > 4.0 Mean gradient (mmhg) < > 40 Valve area (cm 2 ) 1.0 Valve area index (cm 2 /m 2 ) 0.6 6

7 Minners J, et al. Eur Heart J 2008;29: AVA 1.0cm2 & Mean PG < 40mmHg LVEF < 50% 50% SV index (ml/m 2 ) 35 >35 Classical LF LG AS Paradoxical LF LG AS Normal-flow LG AS Clavel MA et al., Eur Heart J,

8 67 year old female with exertional dyspnea Case: low gradient AS with depressed LVEF LVOT diameter 2.0 cm LVOT TVI 12.5cm AV Vmax 3.7m/s Mean PG 35mmHg

9 Pibarot P and Dumesnil JG. J Am Coll Cardiol 2012;60: Baseline LVOT TVI 13.2cm Vmax 3.6m/sec PG 51/32mmHg AVA 0.52cm 2 Dobutamine 5 μg LVOT TVI 13.8cm Vmax 4.1m/sec PG 66/41mmHg Dobutamine 10 μg LVOT TVI 14.4cm Vmax 4.8m/sec PG 93/54mmHg AVA 0.50cm 2 9

10 Low-gradient severe AS with depressed LVEF - Low LVEF (<40%) causing low stroke volume - True severe AS versus pseudosevere AS Paradoxical Low-flow, Low-gradient severe AS with preserved LVEF - Severe concentric LVH and smaller LV cavity size - High valvuloarterial impedance and low stroke volume Pibarot P and Dumesnil JG. J Am Coll Cardiol 2012;60:

11 Impaired Diastolic Filling Pronounced Concentric Remodeling Atrial Fibrillation Impaired Longitudinal Systolic function Reduced Forward Stroke Volume Reduced Transvalvular flow rate Mitral Regurgitation Mitral Stenosis Tricuspid Regurgitation Low-Flow, Low gradient AS with Preserved LVEF Pibarot P, Dumesnil JG. Circulation 2013: NF group PLF surgical NF surgical Survival (%) P=0.006 PLF group Survival (%) P<0.001 PLF medical NF medical Follow-up (year) Follow-up (year) Hachicha Z, et al. Circulation 2007;115:

12 1.0 Unadjusted 1.0 Adjusted 0.8 AVR 0.8 Survival (%) Standard Survival (%) AVR Standard Log rank P< HR: 2.03, P= Follow up, (month) Follow up, (month) Ozkan et al. Circulation 2013;128: PARTNER-I B (inoperable): Medical vs. TAVR 2-Year Death (%) LF-Cohort B-TAVR LF-Cohort B-MM Log Rank P< % 45.9% No. at Risk Time in Days B-TAVR B-MM Year Death (%) LF,NEF and-lg-cohort B-TAVR LF,NEF and LG-Cohort B-MM Log Rank P= % 56.5% No. at Risk Time in Days B-TAVR B-MM Herrman HC et al, Circulation,

13 AVA < 1.0 cm 2 Low gradient (severe?) AS LVEF < 50% Low LVEF 50% Preserved LVEF Classical Low-Flow, Low-gradient AS D2 Stage < 35 ml/m 2 Low Flow Paradox, Low Flow, Low-gradient AS D3 Stage Flow SVi 35 ml/m 2 Normal Flow Normal Flow, Low-gradient AS? Stage Confirm AS severity: 2D echo, DSE, MDCT Assess surgical risk Confirm AS severity: 2D echo, MDCT Assess surgical risk Confirm AS severity: 2D echo, MDCT AVR-Class IIa TAVR > SAVR? AVR-Class IIa TAVR > SAVR? AVR? SAVR or TAVR Pibarot P et al. J Am Coll Cardiol 2016: AVA 1.0cm2 & Mean PG < 40mmHg LVEF < 50% 50% SV index (ml/m 2 ) 35 >35 Classical LF LG AS Paradoxical LF LG AS Normal-flow LG AS Clavel MA et al., Eur Heart J,

14 Case: 70 year old male with low gradient AS and dyspnea Case: low gradient AS with preserved LV ejection fraction LVOT 2.08 cm LVOT TVI 25 cm AV Vmax 3.7 m/s meanpg 35 mmhg AV TVI 90 cm AVA LVOT cm BSA = 1.77 m 2 AVAI = 0.53 cm 2 /m 2 Stroke Volume = 80.0 ml SVI = 45.2 ml/m 2 14

15 Paradoxical Low-flow, Low-gradient severe AS - Severe concentric LVH and smaller LV cavity size - High valvuloarterial impedance and low stroke volume Normal-flow, Low-gradient severe AS - Measurement error - Small body surface area - Inconsistency between cutoff values of AVA and gradient Aortic valve area (cm 2 ) Mean gradient (mmhg) Carabello BA. N Engl J Med 2002;346:677 15

16 AVA < 1.0 cm 2 Low gradient (severe?) AS LVEF < 50% Low LVEF 50% Preserved LVEF Classical Low-Flow, Low-gradient AS D2 Stage < 35 ml/m 2 Low Flow Paradox, Low Flow, Low-gradient AS D3 Stage Flow SVi 35 ml/m 2 Normal Flow Normal Flow, Low-gradient AS? Stage Confirm AS severity: 2D echo, DSE, MDCT Assess surgical risk Confirm AS severity: 2D echo, MDCT Assess surgical risk Confirm AS severity: 2D echo, MDCT AVR-Class IIa TAVR > SAVR? AVR-Class IIa TAVR > SAVR? AVR? Pibarot P et al. J Am Coll Cardiol 2016: Watchful Observation Versus Early Aortic Valve Replacement for Patients with Normal flow, Low Gradient Severe Aortic Stenosis Duk-Hyun Kang, Jeong Yoon Jang, Sung-Ji Park, Dae Hee Kim, Jong-Min Song, Seung Woo Park, Jae-Kwan Song, Jae Won Lee, Seung-Jung Park Asan and Samsung Medical Center Seoul, Korea Kang DH, et al. Heart 2015;

17 Study Flow Normal flow LG AS (n = 284) Early AVR Group (n = 98, 35%) Early elective AVR within 6 months after initial echocardiography Watchful Observation Group (n = 186, 65%) Referred for late AVR Symptoms worsened Aortic jet velocity > 4 m/s Mean gradient > 40 mmhg Clinical and Echocardiographic follow-up until June 2014 Kang DH, et al. Heart 2015; Overall mortality rate, % p = year overall mortality rate Early AVR Watchful Observation 17 ± 5 % 27 ± 5% No. at Risk Early AVR Watchful Observation Time after baseline, years

18 100 CV mortality rate, % p = year CV mortality rate Early AVR Watchful Observation 11 ± 4 % 18 ± 4 % No. at Risk Early AVR Watchful Observation Time after baseline, years Overall mortality rate, % p = year overall mortality rate Early AVR Watchful Observation 20 ± 5% 22 ± 7 % No. at Risk Early AVR Watchful Observation Time after baseline, years

19 75 year old female with exertional dyspnea AV Vmax 3.8 m/s AV TVI 89 cm LVOT 1.96 cm AVA... LVOT TVI 20.4 cm BSA = 1.57 m 2 AVAI = 0.43 cm 2 /m 2 SVI = 39.2 ml/m 2 Case. What is your diagnosis? 1) Moderate AS 2) High-gradient Severe AS 3) Normal-flow, Low-gradient Severe AS 4) Low-flow, Low-gradient Severe AS 19

20 75 year old female with high gradient, severe AS AV Vmax 3.8 m/s AV Vmax 4.2 m/s Case. What is your diagnosis? 1) Moderate AS 2) High-gradient Severe AS 3) Normal-flow, Low-gradient Severe AS 4) Low-flow, Low-gradient Severe AS 20

21 Flow gradient pattern, AVA, ejection fraction, symptoms and operative risk should be considered in a decision for AVR in severe AS Clinical trials are required to evaluate benefit of surgical AVR or TAVR for symptomatic patients with LG severe AS and asymptomatic patients with very severe AS 21

Early Surgery in Asymptomatic Severe Aortic Stenosis Pros and Cons

Early Surgery in Asymptomatic Severe Aortic Stenosis Pros and Cons Early Surgery in Asymptomatic Severe Aortic Stenosis Pros and Cons Duk-Hyun Kang, M.D. Division of Cardiology Asan Medical Center Seoul, Korea Background Dilemma of balancing the risks versus benefits

More information

«Paradoxical» low-flow, low-gradient AS with preserved LV function: A Silent Killer

«Paradoxical» low-flow, low-gradient AS with preserved LV function: A Silent Killer «Paradoxical» low-flow, low-gradient AS with preserved LV function: A Silent Killer Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Université LAVAL

More information

Low Gradient Severe? AS

Low Gradient Severe? AS Low Gradient Severe? AS Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Institut Universitaire de Cardiologie et de Pneumologie de Québec / Québec Heart

More information

Aortic Valve Replacement Improves Outcome in Patients with Preserved Ejection Fraction: PRO!

Aortic Valve Replacement Improves Outcome in Patients with Preserved Ejection Fraction: PRO! ESC 2011, Paris Controversies in Low-Flow, Low-Gradient Aortic Stenosis Aortic Valve Replacement Improves Outcome in Patients with Preserved Ejection Fraction: PRO! Philippe Pibarot, DVM, PhD, FACC, FAHA,

More information

ECHO HAWAII. Role of Stress Echo in Valvular Heart Disease. Not only ischemia! Cardiomyopathy. Prosthetic Valve. Diastolic Dysfunction

ECHO HAWAII. Role of Stress Echo in Valvular Heart Disease. Not only ischemia! Cardiomyopathy. Prosthetic Valve. Diastolic Dysfunction Role of Stress Echo in Valvular Heart Disease ECHO HAWAII January 15 19, 2018 Kenya Kusunose, MD, PhD, FASE Tokushima University Hospital Japan Not only ischemia! Cardiomyopathy Prosthetic Valve Diastolic

More information

Sténose aortique à Bas Débit et Bas Gradient

Sténose aortique à Bas Débit et Bas Gradient 3.6 m/s Sténose aortique à Bas Débit et Bas Gradient Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Doctorate Honoris Causa, Université de Liège Institut

More information

Low Gradient Severe AS: Who Qualifies for TAVR? Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor

Low Gradient Severe AS: Who Qualifies for TAVR? Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Low Gradient Severe AS: Who Qualifies for TAVR? Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central Michigan University

More information

Low Gradient AS: Multi-Imaging Modalities

Low Gradient AS: Multi-Imaging Modalities Low Gradient AS: Multi-Imaging Modalities Philippe Pibarot, DVM, PhD, FACC, FAHA, FESC, FASE Canada Research Chair in Valvular Heart Diseases Institut Universitaire de Cardiologie et de Pneumologie de

More information

MAKING SENSE OF MODERATE GRADIENTS IN PATIENTS WITH SYMPTOMATIC AORTIC STENOSIS

MAKING SENSE OF MODERATE GRADIENTS IN PATIENTS WITH SYMPTOMATIC AORTIC STENOSIS MAKING SENSE OF MODERATE GRADIENTS IN PATIENTS WITH SYMPTOMATIC AORTIC STENOSIS David A. Orsinelli, MD, FACC, FASE Professor, Internal Medicine Director, Structural Heart Imaging The Ohio State University

More information

Aortic Valve Stenosis: Flow and Gradient stratification and association with TAVR outcomes

Aortic Valve Stenosis: Flow and Gradient stratification and association with TAVR outcomes Aortic Valve Stenosis: Flow and Gradient stratification and association with TAVR outcomes Kostis Raisakis General Hospital of Athens «G. Gennimatas» Severe Aortic Stenosis Peak Velocity 4 m/s Up to 40%

More information

Managing the Low Output Low Gradient Aortic Stenosis Patient

Managing the Low Output Low Gradient Aortic Stenosis Patient Managing the Low Output Low Gradient Aortic Stenosis Patient R A Nishimura MD Judd and Mary Leighton Professor of CV Mayo Clinic No disclosures Valvular Stenosis Severity of Aortic Stenosis Mean gradient

More information

Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants

Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Aortic Stenosis: Spectrum of Disease, Low Flow/Low Gradient and Variants Martin G. Keane, MD, FASE Professor of Medicine Lewis Katz School of Medicine at Temple University Basic root structure Parasternal

More information

Aortic Valvular Stenosis

Aortic Valvular Stenosis Aortic Valvular Stenosis How to Assess the Four Variables for Management Low Flow / Low Gradient / Normal EF / Low EF Patrick T. O Gara, MD, MACC Brigham and Women s Hospital Harvard Medical School No

More information

Stage of Valvular AS. Outline 10/14/16. Low-flow and Other Challenges to the Assessment of Aortic Stenosis. Severe AS

Stage of Valvular AS. Outline 10/14/16. Low-flow and Other Challenges to the Assessment of Aortic Stenosis. Severe AS Low-flow and Other Challenges to the Assessment of Aortic Stenosis Nithima Ratanasit, MD, FACC, FASE Siriraj Hospital, Mahidol University Bangkok, Thailand Outline Types of low-flow aortic stenosis Assessment

More information

Valvular Guidelines: The Past, the Present, the Future

Valvular Guidelines: The Past, the Present, the Future Valvular Guidelines: The Past, the Present, the Future Robert O. Bonow, MD, MS Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital Editor-in-Chief,

More information

Paradoxical low flow-low gradient severe aortic stenosis: where are we?

Paradoxical low flow-low gradient severe aortic stenosis: where are we? Journées Européennes de la SFC Paris, 15 janvier 2016 Paradoxical low flow-low gradient severe aortic stenosis: where are we? Nicolas Mansencal Hôpital Ambroise Paré, Boulogne Centre de Réf ce pour les

More information

Natural History and Echo Evaluation of Aortic Stenosis

Natural History and Echo Evaluation of Aortic Stenosis Natural History and Echo Evaluation of Aortic Stenosis Prof. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM AORTIC STENOSIS First valvular disease

More information

Aortic Valve Stenosis: When stress TTE and/or TEE is required to make the diagnosis and guide treatment

Aortic Valve Stenosis: When stress TTE and/or TEE is required to make the diagnosis and guide treatment Aortic Valve Stenosis: When stress TTE and/or TEE is required to make the diagnosis and guide treatment Stefanos Karagiannis MD PhD Cardiologist Director Echocardiology Dpt Athens Medical Center ESC 2017

More information

Spotlight on Valvular Heart Disease Guidelines

Spotlight on Valvular Heart Disease Guidelines Spotlight on Valvular Heart Disease Guidelines Aortic Valve Disease Raphael Rosenhek Department of Cardiology Medical University of Vienna Palermo, April 26 th 2018 1998 2002 2006 2007 2008 2012 2014 2017

More information

Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know

Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know Aortic Valve Practice Guidelines: What Has Changed and What You Need to Know James F. Burke, MD Program Director Cardiovascular Disease Fellowship Lankenau Medical Center Disclosure Dr. Burke has no conflicts

More information

Dobutamine Stress testing In Low Flow, Low EF, Low Gradient Aortic Stenosis Case Studies

Dobutamine Stress testing In Low Flow, Low EF, Low Gradient Aortic Stenosis Case Studies Dobutamine Stress testing In Low Flow, Low EF, Low Gradient Aortic Stenosis Case Studies Mitral Regurgitation The New ASE Guidelines: Role of 2D/3D and CMR William A. Zoghbi MD, FASE, MACC Professor and

More information

Aortic stenosis aetiology: morphology of calcific AS,

Aortic stenosis aetiology: morphology of calcific AS, How to improve patient selection in aortic stenosis? Fausto J. Pinto, FESC Aortic stenosis aetiology: morphology of calcific AS, bicuspid valve, and rheumatic AS (Adapted from C. Otto, Principles of

More information

Nothing to Disclose. Questions. Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Paul Wood at the Nathanson Lecture, 1958

Nothing to Disclose. Questions. Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Paul Wood at the Nathanson Lecture, 1958 Disclosure Asymptomatic Severe Aortic Stenosis: (When) Should One Intervene? Nothing to Disclose Gabriel Gregoratos, MD, FACC, FAHA Questions Can one improve globally on the asymptomatic state? and if

More information

Low gradient severe aortic stenosis with preserved left ventricular ejection fraction

Low gradient severe aortic stenosis with preserved left ventricular ejection fraction Review Article Low gradient severe aortic stenosis with preserved left ventricular ejection fraction Alper Ozkan Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA Corresponding to: Alper

More information

Severe Asymptomatic Aortic Stenosis

Severe Asymptomatic Aortic Stenosis Severe Asymptomatic Aortic Stenosis The Clinician s Perspective Robert O. Bonow, MD, MS Northwestern University Feinberg School of Medicine Bluhm Cardiovascular Institute Northwestern Memorial Hospital

More information

Comprehensive Echo Assessment of Aortic Stenosis

Comprehensive Echo Assessment of Aortic Stenosis Comprehensive Echo Assessment of Aortic Stenosis Smonporn Boonyaratavej, MD, MSc King Chulalongkorn Memorial Hospital Bangkok, Thailand Management of Valvular AS Medical and interventional approaches to

More information

Role of Stress Echo in Valvular Heart Disease. Satoshi Nakatani Osaka University Graduate School of Medicine Osaka, Japan

Role of Stress Echo in Valvular Heart Disease. Satoshi Nakatani Osaka University Graduate School of Medicine Osaka, Japan Role of Stress Echo in Valvular Heart Disease Satoshi Nakatani Osaka University Graduate School of Medicine Osaka, Japan Exercise echocardiography Dobutamine echocardiography Usefulness of exercise echo

More information

Load and Function - Valvular Heart Disease. Tom Marwick, Cardiovascular Imaging Cleveland Clinic

Load and Function - Valvular Heart Disease. Tom Marwick, Cardiovascular Imaging Cleveland Clinic Load and Function - Valvular Heart Disease Tom Marwick, Cardiovascular Imaging Cleveland Clinic Indications for surgery in common valve lesions Risks Operative mortality Failed repair - to MVR Operative

More information

The best in heart valve disease Aortic valve stenosis

The best in heart valve disease Aortic valve stenosis The best in heart valve disease Aortic valve stenosis Marie Moonen, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, BELGIUM My declaration of interest : I have nothing to declare Prevalence

More information

SONOGRAPHER & NURSE LED VALVE CLINICS

SONOGRAPHER & NURSE LED VALVE CLINICS SONOGRAPHER & NURSE LED VALVE CLINICS Frequency of visits and alerts AORTIC STENOSIS V max > 4.0 m/s or EOA < 1.0 cm 2 V max 3.5 4.0 m/s + Ca+ V max 3.0 4.0 m/s or EOA 1.0-1.5 cm 2 V max 2.5 3.0 m/s every

More information

Outcome of Patients With Aortic Stenosis, Small Valve Area, and Low-Flow, Low-Gradient Despite Preserved Left Ventricular Ejection Fraction

Outcome of Patients With Aortic Stenosis, Small Valve Area, and Low-Flow, Low-Gradient Despite Preserved Left Ventricular Ejection Fraction Journal of the American College of Cardiology Vol. 60, No. 14, 2012 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2011.12.054

More information

Stress Testing in Valvular Disease

Stress Testing in Valvular Disease 2017 ASE Florida Orlando, FL October 10, 2017 2:40 2:50 PM 10 min Grand Harbor Ballroom South Stress Testing in Valvular Disease Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate

More information

Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France

Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France Management of significant asymptomatic aortic stenosis. Alec Vahanian Bichat Hospital University Paris VII Paris, France Background Aortic stenosis (AS) is the most frequent valve disease among referred

More information

Asymptomatic Valvular Disease:

Asymptomatic Valvular Disease: Asymptomatic Valvular Disease: Can Echocardiography Help You Decide When to Intervene? Neil J. Weissman, MD MedStar Health Research Inst at MedStar Washington Hospital Center & Professor of Medicine Georgetown

More information

Affecting the elderly Requiring new approaches. Echocardiographic Evaluation of Hemodynamic Severity. Increasing prevalence Mostly degenerative

Affecting the elderly Requiring new approaches. Echocardiographic Evaluation of Hemodynamic Severity. Increasing prevalence Mostly degenerative Echocardiographic Evaluation of Hemodynamic Severity Steven J. Lester MD, FACC, FRCP(C), FASE Mayo Clinic, Arizona Relevant Financial Relationship(s) None Off Label Usage None A re-emerging public-health

More information

Primary Mitral Regurgitation

Primary Mitral Regurgitation EURO VALVE Madrid News from Valves Guidelines 2012: What s new and Why? Primary Mitral Regurgitation Luc A. Pierard, MD, PhD Professor of Medicine Head of the Department of Cardiology Heart Valve Clinic,

More information

Workshop Facing the challenge of TAVI 2016

Workshop Facing the challenge of TAVI 2016 Workshop Facing the challenge of TAVI 2016 Congrès annuel de la SSC Lausanne 15 Juin 2016 Pitfalls in the severity assessment of aortic stenosis by echocardiography Hajo Müller, unité d échocardiographie,

More information

AS with reduced LV ejection fraction: Contractile reserve should be systematically assessed: PRO

AS with reduced LV ejection fraction: Contractile reserve should be systematically assessed: PRO AS with reduced LV ejection fraction: Contractile reserve should be systematically assessed: PRO Jean-Luc MONIN, MD, PhD Henri Mondor University Hospital Créteil, FRANCE Potential conflicts of interest

More information

Aortic Stenosis: UPDATE Anjan Sinha, MD Krannert Institute of Cardiology

Aortic Stenosis: UPDATE Anjan Sinha, MD Krannert Institute of Cardiology Aortic Stenosis: UPDATE 2010 Anjan Sinha, MD Krannert Institute of Cardiology None Disclosures 67-Year-Old Male Dyspnea and angina Class III heart failure No PND or orthopnea 3/6 late peak SEM Diminished

More information

Usually we DON T need to go beyond the gradient

Usually we DON T need to go beyond the gradient Aortic Stenosis Going Beyond the Gradient James D. Thomas, MD, FACC, FASE Director, Center for Heart Valve Disease Bluhm Cardiovascular Institute Professor of Medicine, Feinberg School of Medicine, Northwestern

More information

TAVR: Echo Measurements Pre, Post And Intra Procedure

TAVR: Echo Measurements Pre, Post And Intra Procedure 2017 ASE Florida, Orlando, FL October 10, 2017 8:00 8:25 AM 25 min TAVR: Echo Measurements Pre, Post And Intra Procedure Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate

More information

Low Gradient AS Normal LVEF

Low Gradient AS Normal LVEF Low Gradient AS Normal LVEF Shahbudin H. Rahimtoola MB, FRCP, MACP, MACC, FESC, D.Sc.(Hon) Distinguished Professor University of Southern California Griffith Professor of Cardiology Professor of Medicine

More information

LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital

LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV geometric and functional changes in VHD: How to assess? Mi-Seung Shin M.D., Ph.D. Gachon University Gil Hospital LV inflow across MV LV LV outflow across AV LV LV geometric changes Pressure overload

More information

DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES

DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES THORAXCENTRE DOPPLER HEMODYNAMICS (1) QUANTIFICATION OF PRESSURE GRADIENTS and INTRACARDIAC PRESSURES J. Roelandt DOPPLER HEMODYNAMICS Intracardiac pressures and pressure gradients Volumetric measurement

More information

Exercise Testing/Echocardiography in Asymptomatic AS

Exercise Testing/Echocardiography in Asymptomatic AS Exercise Testing/Echocardiography in Asymptomatic AS Raluca Dulgheru, MD Heart Valve Clinic, University of Liège, CHU Sart Tilman, BELGIUM Disclosure related to this presentation: None VALVULAR HEART DISEASE

More information

Exercise Pulmonary Hypertension predicts the Occurrence of Symptoms in Asymptomatic Degenerative Mitral Regurgitation

Exercise Pulmonary Hypertension predicts the Occurrence of Symptoms in Asymptomatic Degenerative Mitral Regurgitation Exercise Pulmonary Hypertension predicts the Occurrence of Symptoms in Asymptomatic Degenerative Mitral Regurgitation Julien Magne, PhD, Kim O Connor, MD, Giuseppe Romano, MD, Marie Moonen, MD, Luc A.

More information

Echo evaluation for TAVR. From the General Cardiologist to the Interventional Echocardiologist

Echo evaluation for TAVR. From the General Cardiologist to the Interventional Echocardiologist Echo evaluation for TAVR From the General Cardiologist to the Interventional Echocardiologist Disclosures Proctoring activities for Abbott Vascular I and the HYGEIA Hospital «Heart Team» have received

More information

Relevant Financial Relationship(s) Off Label Usage. None. None

Relevant Financial Relationship(s) Off Label Usage. None. None Different Variants Amr E Abbas, MD, FACC, FSCAI, FASE, FSVM Director, Interventional Cardiology Research Beaumont Health Associate Professor of Medicine, OU/WB School of Medicine ASCeXAM/ReASCeXAM 2018

More information

TAVR-Update Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central

TAVR-Update Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central TAVR-Update Andrzej Boguszewski MD, FACC, FSCAI Vice Chairman, Cardiology Mid-Michigan Health Associate Professor Michigan State University, Central Michigan University 1 Disclosure Chiesi Pharma- Consultant

More information

Assessment and Preparation of Patients with TAVI. Rob Tanzola Associate Professor, Queen s University

Assessment and Preparation of Patients with TAVI. Rob Tanzola Associate Professor, Queen s University Assessment and Preparation of Patients with TAVI Rob Tanzola Associate Professor, Queen s University My patient has aortic stenosis and needs non-cardiac surgery Should (s)he get a TAVI? Rob Tanzola Associate

More information

Aortic Stenosis.

Aortic Stenosis. Aortic Stenosis www.cardiconcept.com Common causes Normal Rheumatic (Rim or Commissures) Calcific Degenerative Bicuspid Adapted from C. Otto, Principles of Echocardiography, 2007 Rare causes Congenital

More information

Five-Year Outcomes of Transcatheter Aortic Valve Replacement (TAVR) in Inoperable Patients With Severe Aortic Stenosis: The PARTNER Trial

Five-Year Outcomes of Transcatheter Aortic Valve Replacement (TAVR) in Inoperable Patients With Severe Aortic Stenosis: The PARTNER Trial Five-Year Outcomes of Transcatheter Aortic Valve Replacement (TAVR) in Inoperable Patients With Severe Aortic Stenosis: The PARTNER Trial Samir R. Kapadia, MD On behalf of The PARTNER Trial Investigators

More information

Case Reviews: Hemodynamic Calculations in Valvular Regurgitation

Case Reviews: Hemodynamic Calculations in Valvular Regurgitation Case Reviews: Hemodynamic Calculations in Valvular Regurgitation Case 5 History: 69-year-old man with orthotopic heart transplant 15 years ago. Inferior MI several years ago. Recurrent CHF. Currently dyspneic

More information

Prosthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis

Prosthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis Prosthesis-Patient Mismatch in High Risk Patients with Severe Aortic Stenosis in a Randomized Trial of a Self-Expanding Prosthesis George L. Zorn, III On Behalf of the CoreValve US Clinical Investigators

More information

2/15/2018 DISCLOSURES OBJECTIVES. Consultant for BioSense Webster, a J&J Co. Aortic stenosis background. Short history of TAVR

2/15/2018 DISCLOSURES OBJECTIVES. Consultant for BioSense Webster, a J&J Co. Aortic stenosis background. Short history of TAVR TRANSCATHETER AORTIC VALVE REPLACEMENT IN 2018: IS IT NOW THE STANDARD OF CARE? 22 ND ANNUAL COASTAL CARDIAC & VASCULAR CONFERENCE FEBRUARY 17, 2018 R. David Anderson, MD, MS, FACC, FSCAI Professor of

More information

Prosthetic valve dysfunction: stenosis or regurgitation

Prosthetic valve dysfunction: stenosis or regurgitation Prosthetic valve dysfunction: stenosis or regurgitation Jean G. Dumesnil MD, FRCP(C), FACC, FASE(Hon) Quebec Heart and Lung Institute, Québec, Québec No disclosures Possible Causes of High Gradients in

More information

Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis

Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis Original Article Print ISSN 1738-5520 On-line ISSN 1738-5555 Korean Circulation Journal Role of Transesophageal Echocardiography in the Diagnosis of Paradoxical Low Flow, Low Gradient Severe Aortic Stenosis

More information

A patient with aortic stenosis and LV dysfunction EuroECHO & Other Imaging Modalities 2012 Athens, Greece

A patient with aortic stenosis and LV dysfunction EuroECHO & Other Imaging Modalities 2012 Athens, Greece A patient with aortic stenosis and LV dysfunction EuroECHO & Other Imaging Modalities 2012 Athens, Greece Jean-Luc MONIN, MD, PhD. University Hospital, Créteil, FRANCE My disclosures: Lecture and/ or consulting

More information

Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis?

Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis? EuroValves 2015, Nice Prosthesis-Patient Mismatch or Prosthetic Valve Stenosis? Philippe Pibarot, DVM, PhD, FACC, FAHA, FASE FESC Canada Research Chair in Valvular Heart Diseases Université LAVAL Disclosure

More information

Aortic Stenosis Steven F. Bolling, M.D. Professor of Cardiac Surgery University of Michigan

Aortic Stenosis Steven F. Bolling, M.D. Professor of Cardiac Surgery University of Michigan Aortic Stenosis - 2011 Steven F. Bolling, M.D. Professor of Cardiac Surgery University of Michigan Aortic Surgery Aortic Stenosis EB CT - Ca++ everywhere! Surgery for Aortic Stenosis 100,000 USA + 100,000

More information

Hemodynamic Assessment. Assessment of Systolic Function Doppler Hemodynamics

Hemodynamic Assessment. Assessment of Systolic Function Doppler Hemodynamics Hemodynamic Assessment Matt M. Umland, RDCS, FASE Aurora Medical Group Milwaukee, WI Assessment of Systolic Function Doppler Hemodynamics Stroke Volume Cardiac Output Cardiac Index Tei Index/Index of myocardial

More information

Mixed aortic valve disease

Mixed aortic valve disease Mixed aortic valve disease IOANNIS NTALAS MD, PhD Cardiologist, Clinical Fellow in Cardiovascular Imaging & Non-Invasive Cardiology, St Thomas Hospital School of Biomedical Engineering & Imaging Sciences

More information

Michigan Society of Echocardiography 30 th Year Jubilee

Michigan Society of Echocardiography 30 th Year Jubilee Michigan Society of Echocardiography 30 th Year Jubilee Stress Echocardiography in Valvular Heart Disease Moving Beyond CAD Karthik Ananthasubramaniam, MD FRCP (Glas) FACC FASE FASNC Associate Professor

More information

Aortic valve Stenosis: Insights in the evaluation of LV function. Erwan DONAL Cardiologie CHU Rennes

Aortic valve Stenosis: Insights in the evaluation of LV function. Erwan DONAL Cardiologie CHU Rennes Aortic valve Stenosis: Insights in the evaluation of LV function Erwan DONAL Cardiologie CHU Rennes erwan.donal@chu-rennes.fr Preload Afterload Myocardial Fiber Shortening Circumferential Longitudinal

More information

How to Avoid Prosthesis-Patient Mismatch

How to Avoid Prosthesis-Patient Mismatch How to Avoid Prosthesis-Patient Mismatch Philippe Pibarot, DVM, PhD, FACC, FAHA, FASE, FESC Canada Research Chair in Valvular Heart Diseases INSTITUT UNIVERSITAIRE DE CARDIOLOGIE ET DE PNEUMOLOGIE DE QUÉBEC

More information

Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC

Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC Aortic Stenosis and TAVR TARUN NAGRANI, MD INTERVENTIONAL AND ENDOVASCULAR CARDIOLOGIST, SOMC No Financial Disclosures Aortic Stenosis AS is an insidious disease with a long latency period followed by

More information

Vinod H. Thourani, MD

Vinod H. Thourani, MD Triggers for Aortic Stenosis and Regurgitation Vinod H. Thourani, MD Professor of Surgery Chair, Department of Cardiac Surgery MedStar Heart and Vascular Institute Georgetown University Washington, DC,

More information

TAVR IN INTERMEDIATE-RISK PATIENTS

TAVR IN INTERMEDIATE-RISK PATIENTS TAVR IN INTERMEDIATE-RISK PATIENTS K. Lampropoulos MD, PhD, FESC, MEAPCI Interventional Cardiologist Evangelismos General Hospital The Burden of Valve Disease Prevalence Survival NATURAL HISTORY OF AS

More information

Echocardiographic Evaluation of Aortic Valve Prosthesis

Echocardiographic Evaluation of Aortic Valve Prosthesis Echocardiographic Evaluation of Aortic Valve Prosthesis Amr E Abbas, MD, FACC, FASE, FSCAI, FSVM, RPVI Co-Director, Echocardiography, Director, Interventional Cardiology Research, Beaumont Health System

More information

Diastolic Function Assessment Practical Ways to Incorporate into Every Echo

Diastolic Function Assessment Practical Ways to Incorporate into Every Echo Diastolic Function Assessment Practical Ways to Incorporate into Every Echo Jae K. Oh, MD Echo Hawaii 2018 2018 MFMER 3712003-1 Learning Objectives My presentation will help you to Appreciate the importance

More information

Clinical Outcome in Patients with Aortic Stenosis

Clinical Outcome in Patients with Aortic Stenosis Clinical Outcome in Patients with Aortic Stenosis Is the Prognosis Worse in Patients with Low-Gradient Severe Aortic Stenosis? Yoel Angel BSc, Shemy Carasso MD, Diab Mutlak MD, Jonathan Lessick MD Dsc,

More information

A new way to look at the aortic valve

A new way to look at the aortic valve The aortic valve: impedance, misfits and bulges Felix J. Rogers, DO, FASE Oakwood Southshore Medical Center January 24, 2010 A new way to look at the aortic valve Aortic stenosis patients with the same

More information

Patient/prosthesis mismatch: how to evaluate and when to act?

Patient/prosthesis mismatch: how to evaluate and when to act? Patient/prosthesis mismatch: how to evaluate and when to act? Svend Aakhus, MD, PhD Oslo University Hospital, Norway Disclosures: No conflict of interest Types of aortic valve prostheses (AVR) Mechanical

More information

Transcatheter Aortic Valve Replacement: Current and Future Devices: How do They Work, Eligibility, Review of Data

Transcatheter Aortic Valve Replacement: Current and Future Devices: How do They Work, Eligibility, Review of Data Transcatheter Aortic Valve Replacement: Current and Future Devices: How do They Work, Eligibility, Review of Data Echo Florida 2013 Jonathan J. Passeri, M.D. Co-Director, Heart Valve Program Director,

More information

Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal

Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal Valve Disease in Patients With Heart Failure TAVI or Surgery? Miguel Sousa Uva Hospital Cruz Vermelha Lisbon, Portugal I have nothing to disclose. Wide Spectrum Stable vs Decompensated NYHA II IV? Ejection

More information

HEMODYNAMIC ASSESSMENT

HEMODYNAMIC ASSESSMENT HEMODYNAMIC ASSESSMENT INTRODUCTION Conventionally hemodynamics were obtained by cardiac catheterization. It is possible to determine the same by echocardiography. Methods M-mode & 2D echo alone can provide

More information

Valvular Intervention

Valvular Intervention Valvular Intervention Outline Introduction Aortic Stenosis Mitral Regurgitation Conclusion Calcific Aortic Stenosis Deformed Eccentric Calcified Nodular Rigid HOSTILE TARGET difficult to displace prone

More information

New imaging modalities for assessment of TAVI procedure and results. R Dulgheru, MD Heart Valve Clinic CHU, Liege

New imaging modalities for assessment of TAVI procedure and results. R Dulgheru, MD Heart Valve Clinic CHU, Liege New imaging modalities for assessment of TAVI procedure and results R Dulgheru, MD Heart Valve Clinic CHU, Liege Disclosure of Interest I, Raluca Dulgheru, DO NOT HAVE a financial interest/arrangement

More information

A Health Care Professional s Guide Aortic Stenosis in Seniors

A Health Care Professional s Guide Aortic Stenosis in Seniors A Health Care Professional s Guide Aortic Stenosis in Seniors With highlights from the 2014 ACC/AHA practice guidelines for valve disease Aortic stenosis (AS) is primarily caused by calcification of the

More information

Choose the grading of diastolic function in 82 yo woman

Choose the grading of diastolic function in 82 yo woman Question #1 Choose the grading of diastolic function in 82 yo woman E= 80 cm/s A= 70 cm/s LAVI < 34 ml/m 2 1= Grade 1 2= Grade 2 3= Grade 3 4= Normal 5= Indeterminate 2018 MFMER 3712003-1 Choose the grading

More information

Risk stratification of severe aortic stenosis according to new guidelines: long term outcomes

Risk stratification of severe aortic stenosis according to new guidelines: long term outcomes Original Article Risk stratification of severe aortic stenosis according to new guidelines: long term outcomes Andrea Colli, Eleonora Bizzotto, Laura Besola, Dario Gregori, Francesca Toto, Erica Manzan,

More information

The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery

The Incidence and Predictors of Postoperative Atrial Fibrillation After Noncardiothoracic Surgery ORIGINAL ARTICLE DOI 10.4070 / kcj.2009.39.3.100 Print ISSN 1738-5520 / On-line ISSN 1738-5555 Copyright c 2009 The Korean Society of Cardiology The Incidence and Predictors of Postoperative Atrial Fibrillation

More information

Valvular Heart Disease

Valvular Heart Disease Valvular Heart Disease B K Singh, MD, FACC Disclosures: None 1 CARDIAC CYCLE S2 S2=A2P2 S1=M1T1 S4 S1 S3 2 JVP Carotid S1 Slitting of S2 S3 S4 Ejection click Opening snap Dynamic Auscultation What is the

More information

The prevalence of calcific aortic valve disease approaches. Compendium. Current Management of Calcific Aortic Stenosis

The prevalence of calcific aortic valve disease approaches. Compendium. Current Management of Calcific Aortic Stenosis Compendium Circulation Research Compendium on Aortic Valve Disease: Introduction to the Compendium Introduction to Aortic Stenosis Hemodynamic and Cellular Response Feedback in Calcific Aortic Valve Disease

More information

Severe Aortic Stenosis with Low Gradient and Preserved Ejection Fraction

Severe Aortic Stenosis with Low Gradient and Preserved Ejection Fraction Severe Aortic Stenosis with Low Gradient and Preserved Ejection Fraction Roney Orismar Sampaio, Lucas José Tachotti Pires, Marcelo Luiz Campos Vieira, Flavio Tarasoutchi Instituto do Coração HCFMUSP; Hospital

More information

Severe left ventricular dysfunction and valvular heart disease: should we operate?

Severe left ventricular dysfunction and valvular heart disease: should we operate? Severe left ventricular dysfunction and valvular heart disease: should we operate? Laurie SOULAT DUFOUR Hôpital Saint Antoine Service de cardiologie Pr A. COHEN JESFC 16 janvier 2016 Disclosure : No conflict

More information

TAVR Cases. Disclosures 2/17/2018. February 17, :15 3:30 PM 15 min

TAVR Cases. Disclosures 2/17/2018. February 17, :15 3:30 PM 15 min 31 st Annual State of the Art Echocardiography San Diego, CA February 17, 2018 3:15 3:30 PM 15 min TAVR Cases Muhamed Sarić MD, PhD, MPA Director of Noninvasive Cardiology Echo Lab Associate Professor

More information

Hypertension in Aortic Valve Disease

Hypertension in Aortic Valve Disease Hypertension in Aortic Valve Disease Hanna M. Nosseir MRCP, FRCP Head of Cardiology department Galaa Military Medical Complex Aortic stenosis: Introduction Arterial hypertension and aortic stenosis are

More information

Calcific aortic stenosis (AS) is the most frequent valvular

Calcific aortic stenosis (AS) is the most frequent valvular Special Report Multimodality Imaging Strategies for the Assessment of Aortic Stenosis Viewpoint of the Heart Valve Clinic International Database (HAVEC) Group Raluca Dulgheru, MD; Philippe Pibarot, DVM,

More information

Echocardiographic evaluation of mitral stenosis

Echocardiographic evaluation of mitral stenosis Echocardiographic evaluation of mitral stenosis Euroecho 2011 Philippe Unger, MD, FESC Erasme Hospital, ULB, Brussels, Belgium I have nothing to declare EuroHeart Survey Etiology of single native left-sided

More information

STRUCTURAL. aortic stenosis, transcatheter aortic valve replacement

STRUCTURAL. aortic stenosis, transcatheter aortic valve replacement Received: 4 April 2018 Revised: 17 August 2018 Accepted: 20 August 2018 DOI: 10.1111/joic.12561 STRUCTURAL Outcomes after transcatheter aortic valve replacement in patients with low versus high gradient

More information

Independent Effect of Low Flow on Outcomes in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis

Independent Effect of Low Flow on Outcomes in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis Circ J 2018; 82: 2199 2205 doi: 10.1253/circj.CJ-17-0900 ORIGINAL ARTICLE Valvular Heart Disease Independent Effect of Low Flow on Outcomes in Patients Undergoing Aortic Valve Replacement for Severe Aortic

More information

Echocardiographic Evaluation of Aortic Valve Prosthesis

Echocardiographic Evaluation of Aortic Valve Prosthesis Echocardiographic Evaluation of Aortic Valve Prosthesis Amr E Abbas, MD, FACC, FASE, FSCAI, FSVM, RPVI Co Director, Echocardiography, Director, Interventional Cardiology Research, Beaumont Health System

More information

TAVI After PARTNER-2 : The Hamilton Approach

TAVI After PARTNER-2 : The Hamilton Approach TAVI After PARTNER-2 : The Hamilton Approach James L. Velianou MD FRCPC Interventional Cardiology Hamilton General Hospital St Catharines General Hospital Associate Professor of Medicine McMaster University

More information

TAVR: Intermediate Risk Patients

TAVR: Intermediate Risk Patients TAVR: Intermediate Risk Patients Oscar A. Mendiz.MD.FACC.FSCAI Director Cardiology & Cardiovascular Institute (ICyCC) Chief Interventional Cardiology Department Board of Directors Hospital & Favaloro University

More information

How to assess ischaemic MR?

How to assess ischaemic MR? ESC 2012 How to assess ischaemic MR? Luc A. Pierard, MD, PhD, FESC, FACC Professor of Medicine Head, Department of Cardiology University Hospital Sart Tilman, Liège ESC 2012 No conflict of interest Luc

More information

An Integrated Approach to Study LV Diastolic Function

An Integrated Approach to Study LV Diastolic Function An Integrated Approach to Study LV Diastolic Function Assoc. Prof. Adriana Ilieşiu, FESC University of Medicine Carol Davila Bucharest, Romania LV Diastolic Dysfunction impaired relaxation (early diastole)

More information

Diastolic Function Assessment New Guideline Update Practical Approach

Diastolic Function Assessment New Guideline Update Practical Approach Mayo Clinic Department of Cardiovascular Diseases Mayo Clinic Echocardiography Review Course for Boards and Recertification Diastolic Function Assessment New Guideline Update Practical Approach Jae K.

More information

Stress Echocardiography: Illustrative Cases Sunil Mankad, MD, FACC, FCCP, FASE Associate Professor of Medicine Mayo Clinic College of Medicine Director, Transesophageal Echocardiography Associate Director,

More information

2019 Qualified Clinical Data Registry (QCDR) Performance Measures

2019 Qualified Clinical Data Registry (QCDR) Performance Measures 2019 Qualified Clinical Data Registry (QCDR) Performance Measures Description: This document contains the 18 performance measures approved by CMS for inclusion in the 2019 Qualified Clinical Data Registry

More information