Aortic Valve Stenosis
Conditions
Keywords
Low - flow, Low - gradient, Low - dose dobutamine, Volume challenge, Echocardiography
Brief summary
The aim of this study is to test the diagnostic added value of Volume Challenge (VC) to low-dose dobutamine stress echocardiography (LDDSE) in patients with a low-flow, low-gradient aortic stenosis (LFLGAS). This study will assess if LDDSE plus VC allows to increase the proportion of patients in whom a true severe AS can be differentiated from a pseudo severe AS.
Detailed description
The design of the study is a monocentric prospective non-randomized pilot clinical trial. A standard LDDSE will be performed. The stroke volume (SV) will be recorded. The addition of VC with the passive leg raise method at peak dobutamine dose will be performed. A transesophageal echocardiography (TEE) with low dose dobutamine and a bolus of normal saline will be performed as a validation method to measure AVA with the planimetry method. The SV will be recorded. Proportion of patient receiving the diagnosis of true severe AS defined as a combination of AVA \<1.0 cm2 and ∆SV ≥ 20% will be compared between standard LDDSE and LDDSE with addition of VC. Calculating sensitivity, specificity, performing ROC curve analysis and calculating the Youden-index, the accuracy of the test method (LDDSE plus passive leg raising) for the detection of truly severe AS in comparison with the reference method (TEE) will be determined.
Interventions
DIAGNOSTIC_TESTVolume Challenge
Addition volume challenge with passive leg raising method in LDDSE as well as administration of normal saline and dobutamine during TEE
Sponsors
Insel Gruppe AG, University Hospital Bern
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 years * Written informed consent * Patients with LFLGAS (mean Gradient: \< 40 mmHg, AVA ≤ 1.0 cm2 (by continuity equation using LVOT diameter) SVI ≤ 35 ml/m2), by rest TTE
Exclusion criteria
* Hypersensitivity to dobutamine or midazolam * Lack of safe contraception defined as: Female participants of childbearing potential not using and not willing to continue contraception for study duration, such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices. * Inability to follow the procedures of the study, e.g. due to language problems, psychological disorders, dementia, etc., * Enrolment of the investigator, his/her family members, employees and other dependent persons * Previous enrolment into the current study, ADDITIONAL SPECIFIC
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Diagnosis of true severe AS | Measures taken during echocardiograph a few minutes after administration of VC | Proportion of patients receiving the diagnosis of true severe AS defined as a combination of AVA \<1.0 cm2 and ∆SV ≥ 20% will be compared between standard LDDSE and LDDSE with addition of VC |
Countries
Switzerland
Outcome results
None listed