Clinical Value of Stress Transaortic Flow Rate During Dobutamine Echocardiography in Reduced Left Ventricular Ejection Fraction, Low-Gradient Aortic Stenosis: A Multicenter Study

Anastasia Vamvakidou, Mohamed-Salah Annabi, Phillipe Pibarot, Edyta Plonska-Gosciniak, Ana G Almeida, Ezequiel Guzzetti, Abdellaziz Dahou, Ian G Burwash, Matthias Koschutnik, Philipp E Bartko, Jutta Bergler-Klein, Julia Mascherbauer, Stefan Orwat, Helmut Baumgartner, Joao Cavalcante, Fausto Pinto, Tomasz Kukulski, Jaroslaw D Kasprzak, Marie-Annick Clavel, Frank A FlachskampfRoxy Senior

Research output: Journal article (peer-reviewed)Journal article

4 Citations (Scopus)


Background: Low rest transaortic flow rate (FR) has been shown previously to predict mortality in low-gradient aortic stenosis. However limited prognostic data exists on stress FR during low-dose dobutamine stress echocardiography. We aimed to assess the value of stress FR for the detection of aortic valve stenosis (AS) severity and the prediction of mortality. Methods: This is a multicenter cohort study of patients with reduced left ventricular ejection fraction and low-gradient aortic stenosis (aortic valve area <1 cm 2and mean gradient <40 mm Hg) who underwent low-dose dobutamine stress echocardiography to identify the AS severity and presence of flow reserve. The outcome assessed was all-cause mortality. Results: Of the 287 patients (mean age, 75±10 years; males, 71%; left ventricular ejection fraction, 31±10%) over a mean follow-up of 24±30 months there were 127 (44.3%) deaths and 147 (51.2%) patients underwent aortic valve intervention. Higher stress FR was independently associated with reduced risk of mortality (hazard ratio, 0.97 [95% CI, 0.94-0.99]; P=0.01) after adjusting for age, chronic kidney disease, heart failure symptoms, aortic valve intervention, and rest left ventricular ejection fraction. The minimum cutoff for prediction of mortality was stress FR 210 mL/s. Following adjustment to the same important clinical and echocardiographic parameters, among the three criteria of AS severity during stress, ie, the guideline definition of aortic valve area <1cm 2and aortic valve mean gradient ≥40 mm Hg, or aortic valve mean gradient ≥40 mm Hg, or the novel definition of aortic valve area <1 cm 2at stress FR ≥210 mL/s, only the latter was independently associated with mortality (hazard ratio, 1.72 [95% CI, 1.05-2.82]; P=0.03). Furthermore aortic valve area <1cm 2at stress FR ≥210 mL/s was the only severe aortic stenosis criterion that was associated with improved outcome following aortic valve intervention (P<0.001). Guideline-defined stroke volume flow reserve did not predict mortality. Conclusions: Stress FR during low-dose dobutamine stress echocardiography was useful for the detection of both AS severity and flow reserve and was associated with improved prediction of outcome following aortic valve intervention.

Original languageEnglish
Pages (from-to)e012809
JournalCirculation: Cardiovascular Imaging
Issue number11
Publication statusPublished - 01 Nov 2021


  • Aged
  • Aortic Valve/diagnostic imaging
  • Aortic Valve Stenosis/diagnosis
  • Blood Flow Velocity/physiology
  • Cardiotonic Agents/pharmacology
  • Dobutamine/pharmacology
  • Echocardiography, Stress/methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Stroke Volume/physiology
  • Ventricular Function, Left/physiology
  • heart failure
  • prognosis
  • stroke volume
  • cohort studies
  • echocardiography, stress

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology, Nuclear Medicine and Imaging


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