{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:33:54Z","timestamp":1790883234113,"version":"4.1.0"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Imaging"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This is a multicenter cohort study of patients with reduced left ventricular ejection fraction and low-gradient aortic stenosis (aortic valve area &lt;1 cm\n                      <jats:sup>2<\/jats:sup>\n                      and mean gradient &lt;40 mm\u2009Hg) who underwent low-dose dobutamine stress echocardiography to identify the AS severity and presence of flow reserve. The outcome assessed was all-cause mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Of the 287 patients (mean age, 75\u00b110 years; males, 71%; left ventricular ejection fraction, 31\u00b110%) over a mean follow-up of 24\u00b130 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\u20130.99];\n                      <jats:italic>P<\/jats:italic>\n                      =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 &lt;1cm\n                      <jats:sup>2<\/jats:sup>\n                      and aortic valve mean gradient \u226540 mm\u2009Hg, or aortic valve mean gradient \u226540 mm\u2009Hg, or the novel definition of aortic valve area &lt;1 cm\n                      <jats:sup>2<\/jats:sup>\n                      at stress FR \u2265210 mL\/s, only the latter was independently associated with mortality (hazard ratio, 1.72 [95% CI, 1.05\u20132.82];\n                      <jats:italic>P<\/jats:italic>\n                      =0.03). Furthermore aortic valve area &lt;1cm\n                      <jats:sup>2<\/jats:sup>\n                      at stress FR \u2265210 mL\/s was the only severe aortic stenosis criterion that was associated with improved outcome following aortic valve intervention (\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). Guideline-defined stroke volume flow reserve did not predict mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circimaging.121.012809","type":"journal-article","created":{"date-parts":[[2021,11,8]],"date-time":"2021-11-08T04:02:41Z","timestamp":1636344161000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":20,"title":["Clinical Value of Stress Transaortic Flow Rate During Dobutamine Echocardiography in Reduced Left Ventricular Ejection Fraction, Low-Gradient Aortic Stenosis: A Multicenter Study"],"prefix":"10.1161","volume":"14","author":[{"given":"Anastasia","family":"Vamvakidou","sequence":"first","affiliation":[{"name":"Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom (A.V., R.S.)."},{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom (A.V., R.S.)."},{"name":"Department of Cardiovascular Research, Northwick Park Hospital, Harrow, United Kingdom (A.V., R.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed-Salah","family":"Annabi","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie, Universit\u00e9 Laval, Qu\u00e9bec, Canada (M.-S.A., P.P., E.G., A.D., J.C., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3607-279X","authenticated-orcid":true,"given":"Phillipe","family":"Pibarot","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie, Universit\u00e9 Laval, Qu\u00e9bec, Canada (M.-S.A., P.P., E.G., A.D., J.C., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edyta","family":"Plonska-Gosciniak","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pomeranian Medical University, Szczecin, Poland (E.P.-G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0360-4363","authenticated-orcid":true,"given":"Ana G.","family":"Almeida","sequence":"additional","affiliation":[{"name":"Lisbon University, Hospital Santa Maria\/CHULN, Portugal (A.G.A., F.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezequiel","family":"Guzzetti","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie, Universit\u00e9 Laval, Qu\u00e9bec, Canada (M.-S.A., P.P., E.G., A.D., J.C., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdellaziz","family":"Dahou","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie, Universit\u00e9 Laval, Qu\u00e9bec, Canada (M.-S.A., P.P., E.G., A.D., J.C., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian G.","family":"Burwash","sequence":"additional","affiliation":[{"name":"University of Ottawa Heart Institute, Canada (I.G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Koschutnik","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, Austria (M.K., P.E.B., J.B.-K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp E.","family":"Bartko","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, Austria (M.K., P.E.B., J.B.-K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jutta","family":"Bergler-Klein","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Vienna, Austria (M.K., P.E.B., J.B.-K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Mascherbauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 3, Karl Landsteiner University of Health Sciences, University Hospital St. Polten, Krems, Austria (J.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2836-6333","authenticated-orcid":true,"given":"Stefan","family":"Orwat","sequence":"additional","affiliation":[{"name":"Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Germany (S.O., H.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helmut","family":"Baumgartner","sequence":"additional","affiliation":[{"name":"Department of Cardiology III-Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Germany (S.O., H.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Cavalcante","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie, Universit\u00e9 Laval, Qu\u00e9bec, Canada (M.-S.A., P.P., E.G., A.D., J.C., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8034-4529","authenticated-orcid":true,"given":"Fausto","family":"Pinto","sequence":"additional","affiliation":[{"name":"Lisbon University, Hospital Santa Maria\/CHULN, Portugal (A.G.A., F.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Kukulski","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Congenital Heart Disease and Electrotherapy, Silesian Medical University, Zabrze, Poland (T.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5850-8187","authenticated-orcid":true,"given":"Jaroslaw D.","family":"Kasprzak","sequence":"additional","affiliation":[{"name":"I Department of Cardiology, Medical University of Lodz, Bieganski Hospital, Poland (J.D.K.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8924-740X","authenticated-orcid":true,"given":"Marie-Annick","family":"Clavel","sequence":"additional","affiliation":[{"name":"Institut Universitaire de Cardiologie et de Pneumologie, Universit\u00e9 Laval, Qu\u00e9bec, Canada (M.-S.A., P.P., E.G., A.D., J.C., M.-A.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7401-278X","authenticated-orcid":true,"given":"Frank A.","family":"Flachskampf","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Uppsala University, Sweden (F.A.F.)."},{"name":"Department of Clinical Physiology, Akademiska University Hospital, Uppsala, Sweden (F.A.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6579-7039","authenticated-orcid":true,"given":"Roxy","family":"Senior","sequence":"additional","affiliation":[{"name":"Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom (A.V., R.S.)."},{"name":"National Heart and Lung Institute, Imperial College, London, United Kingdom (A.V., R.S.)."},{"name":"Department of Cardiovascular Research, Northwick Park Hospital, Harrow, United Kingdom (A.V., 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