ECHONOMY
Tools for Echocardiographic Calculations
Muhamed Saric, MD, PhD
New York University
 

DATELINE: US CoreValve trial is schedule to be completed around the middle of 2012.

HIGH RISK ARM: The trial contains a “high risk” arm, defined as an estimated surgical mortality risk of 15%, in which patients are randomized 1:1 against standard surgical AV replacement.

EXTREME RISK ARM: There is also an “extreme risk” registry for patients whose estimated surgical mortality is > 50%. All “extreme risk” patients receive the stent valve. This group, however, must be considered likely to live at least one year, but might be wheel chair bound, excessively frail or have porcelain aorta for example.

INCLUSION CRITERIA: All patients must be symptomatic from severe AS defined as an AV area < 0.8 cm² AND a mean AV gradient >40 mm Hg.

EXCLUSION CRITERIA: Major exclusion criteria are prior heart valve replacement, LVEF < 20%, creatinine clearance < 20 or dialysis, and severe dementia.
 
PRE-ENROLLMENT CATH + ECHO + CT: Prior to enrollment patients must have a cardiac cath to exclude the need for revascularization, an echo to confirm severe AS and abdominal and chest CT scans with contrast to define relevant anatomy related to valve delivery.
 

Inclusion Criteria

Peak Velocity

> 4 m/sec

2.0 cm < AD < 2.7 cm

Exclusion Criteria

Moderate or Severe MS

LVEF < 20%

Basal septal hypertrophy with
LVOT obstruction

Asc aorta > 4.3 cm

Timing of Echo Studies

Reference

CoreValve literature provided by Medtronic, the maker of CoreValve