Epicardial adipose tissue thickness and its association with adiponectin in metabolic syndrome patients from Mérida, Venezuela.

OBJECTIVE: To study the relationship between epicardial adipose tissue (EAT) thickness and plasma levels of adiponectin in Venezuelan patients. SUBJECTS AND METHODS: Thirty-one patients diagnosed with metabolic syndrome (study group) and 27 controls were selected and tested for glycemia, lipids, and adiponectin. EAT thickness, ejection fraction, diastolic function, left ventricular mass (LVM), and left atrial volume (LAV) were determined by transthoracic echocardiography. RESULTS: EAT thickness was greater in metabolic syndrome patients (5.69 ± 1.12 vs. 3.52 ± 0.80 mm; p = 0.0001), correlating positively with body mass index (BMI) (r = 0.661; p = 0.0001); waist circumference (WC) (r = 0.664; p = 0.0001); systolic (SBP) (r = 0.607; p = 0.0001), and diastolic blood pressure (DBP) (r = 0.447; p = 0.0001); insulin (r = 0.505; p = 0.0001); Tg/HDL-C ratio (r = 0.447; p = 0.0001), non-HDL-C (r = 0.353; p = 0.007); LAV (r = 0.432; p = 0.001), and LVM (r = 0.469; p = 0.0001). EAT thickness correlated negatively with adiponectin (r = -0.499; p = 0.0001). CONCLUSION: A significant association exists between EAT thickness and both metabolic syndrome components and adiponectin concentration, a link that might be used as a biomarker for this disease.

Epicardial adipose tissue thickness and its association with adiponectin in metabolic syndrome patients from Mérida, Venezuela / Associação entre a espessura do tecido adiposo epicárdico e a adiponectina em pacientes com síndrome metabólica em Mérida, Venezuela

Objective: To study the relationship between epicardial adipose tissue (EAT) thickness and plasma levels of adiponectin in Venezuelan patients. Subjects and methods: Thirty-one patients diagnosed with metabolic syndrome (study group) and 27 controls were selected and tested for glycemia, lipids, and adiponectin. EAT thickness, ejection fraction, diastolic function, left ventricular mass (LVM), and left atrial volume (LAV) were determined by transthoracic echocardiography. Results: EAT thickness was greater in metabolic syndrome patients (5.69 ± 1.12 vs. 3.52 ± 0.80 mm; p = 0.0001), correlating positively with body mass index (BMI) (r = 0.661; p = 0.0001); waist circumference (WC) (r = 0.664; p = 0.0001); systolic (SBP) (r = 0.607; p = 0.0001), and diastolic blood pressure (DBP) (r = 0.447; p = 0.0001); insulin (r = 0.505; p = 0.0001); Tg/HDL-C ratio (r = 0.447; p = 0.0001), non-HDL-C (r = 0.353; p = 0.007); LAV (r = 0.432; p = 0.001), and LVM (r = 0.469; p = 0.0001). EAT thickness correlated negatively with adiponectin (r = -0.499; p = 0.0001). Conclusion: A significant association exists between EAT thickness and both metabolic syndrome components and adiponectin concentration, a link that might be used as a biomarker for this disease. .

Objetivo: Estudar a relação entre a espessura do tecido adiposo epicárdico (TAE) e os níveis plasmáticos de adiponectina em pacientes venezuelanos. Sujeitos e métodos: Foram selecionados 31 pacientes com diagnóstico de síndrome metabólica (SM) (grupo de estudo) e 27 controles. Foram medidos a glicose, os lipídios e a adiponectina. Foram determinados a espessura do TAE, a fração de ejeção, a função diastólica, a massa ventricular esquerda (MVE) e o volume atrial esquerdo (VAI) pela ecocardiografia transtorácica. Resultados: A espessura do TAE foi maior em pacientes com SM (5,69 ± 1,12 contra 3,52 ± 0,80 mm; p = 0,0001) com uma correlação positiva com o índice de massa corporal (IMC) (r = 0,661; p = 0,0001), circunferência da cintura (CC) (r = 0,664; p = 0,0001), pressão arterial sistólica (PAS) (r = 0,607; p = 0,0001), diastólica (PAD) (r = 0,447; p = 0,0001), insulina (r = 0,505; p = 0,0001), com a relação TG/HDL-C (r = 0,447; p = 0,0001), com o colesterol HDL (r = 0,353; p = 0,007), VAI (r = 0,432; p = 0,001) e MVI (r = 0,469; p = 0,0001). A espessura do TAE se correlacionou negativamente com a adiponectina (r = -0,499; p = 0,0001). Conclusão: Existe uma relação significativa entre a espessura do TAE, os componentes do SM e a concentração plasmática de adiponectina, o que poderia ser utilizado como um biomarcador para essa doença. .

Punto de corte de espesor de tejido adiposo epicárdico para predecir síndrome metabólico en población venezolana / Cut-off point of epicardial adipose tissue thickness for predicting metabolic syndrome in Venezuelan population

Objetivo Definir un punto de corte de espesor de tejido adiposo epicárdico (TAE) medido por ecocardiografía asociado con los componentes del síndrome metabólico (SM) en sujetos venezolanos. Metodología Se seleccionaron 52 sujetos de entre 20 y 65 años con diagnóstico de SM según la Federación Internacional de Diabetes y 45 controles, comparables en edad y sexo. Se midieron glucemia y lípidos plasmáticos. Se determinaron el espesor del TAE y la masa del ventrículo izquierdo mediante ecocardiografía. Resultados No hubo diferencias significativas en edad y sexo entre ambos grupos, y el peso, el índice de masa corporal, la circunferencia abdominal, la presión arterial sistólica y la diastólica fueron significativamente más altos (p = 0,0001) en el grupo con SM. Este grupo presentó niveles significativamente más altos de glucemia en ayunas (p = 0,0001), colesterol total (p = 0,002), c-LDL (p = 0,007), c-noHDL (p = 0,0001), triglicéridos (p = 0,0001), cociente triglicéridos/c-HDL (p = 0,0001) y más bajos de c-HDL (p = 0,0001) que el grupo control. El espesor del TAE (p = 0,0001) y la masa del ventrículo izquierdo (p = 0,017) fueron significativamente mayores en el grupo con SM. La curva operador receptor (COR) demostró un AUC de 0,852 (p = 0,0001), con un poder del test de 0,99. El valor de 5 mm de TAE mostró una sensibilidad del 84,62% (IC 95%: 71,9-93,1) y una especificidad del 71,11% (IC 95%: 55,7-83,6) para predecir SM. La odds ratio de presentar SM en esta población por tener un espesor de TAE ≥ 5 mm fue de 8,25 (IC 95%: 3,15-21,56; p = 0,0001).Conclusión Un valor de TAE ≥ 5 mm presenta una buena sensibilidad y especificidad para predecir SM en población venezolana (AU)

Objective To define an echocardiographically-assessed cut-off point for epicardial adipose tissue (EAT) thickness associated to metabolic syndrome (MS) components in Venezuelan subjects. Methods Fifty-two subjects aged 20-65 years diagnosed with MS according to International Diabetes Federation criteria and 45 sex- and age-matched controls were selected. Blood glucose and plasma lipids were tested; EAT thickness and left ventricular mass were measured by echocardiography. Results No significant age and sex differences were found between the two groups. Body weight, body mass index, waist circumference, and systolic and diastolic blood pressure were significantly higher (P = .0001) in the MS group. This group showed significantly higher levels of fasting blood glucose (P = .0001), total cholesterol (P = .002), LDL-C (P = .007), non-HDL-C (P = .0001), triglycerides (P = .0001), Tg-HDL-C ratio (P = .0001), and lower HDL-C levels (P = .0001) as compared to the control group. EAT thickness (P = .0001) and left ventricular mass (P = .017) were significantly higher in the MS group. The ROC curve showed an AUC of 0.852 (P = .0001) with a power of the test of 0.99. A 5-mm EAT thickness showed a sensitivity of 84.62% (95% CI: 71.9-93.1) and a specificity of 71.11% (95% CI: 55.7-83.6) for predicting MS. The odds ratio of this population for experiencing MS due to an EAT ≥ 5 mm was 8.25 (95% CI: 3.15-21.56; P = .0001).Conclusion An EAT value ≥ 5 mm has good sensitivity and specificity for predicting MS in the Venezuelan population (AU)

[Cut-off point of epicardial adipose tissue thickness for predicting metabolic syndrome in Venezuelan population]. / Punto de corte de espesor de tejido adiposo epicárdico para predecir síndrome metabólico en población venezolana.

OBJECTIVE: To define an echocardiographically-assessed cut-off point for epicardial adipose tissue (EAT) thickness associated to metabolic syndrome (MS) components in Venezuelan subjects. METHODS: Fifty-two subjects aged 20-65 years diagnosed with MS according to International Diabetes Federation criteria and 45 sex- and age-matched controls were selected. Blood glucose and plasma lipids were tested; EAT thickness and left ventricular mass were measured by echocardiography. RESULTS: No significant age and sex differences were found between the two groups. Body weight, body mass index, waist circumference, and systolic and diastolic blood pressure were significantly higher (P=.0001) in the MS group. This group showed significantly higher levels of fasting blood glucose (P=.0001), total cholesterol (P=.002), LDL-C (P=.007), non-HDL-C (P=.0001), triglycerides (P=.0001), Tg-HDL-C ratio (P=.0001), and lower HDL-C levels (P=.0001) as compared to the control group. EAT thickness (P=.0001) and left ventricular mass (P=.017) were significantly higher in the MS group. The ROC curve showed an AUC of 0.852 (P=.0001) with a power of the test of 0.99. A 5-mm EAT thickness showed a sensitivity of 84.62% (95%CI: 71.9-93.1) and a specificity of 71.11% (95%CI: 55.7-83.6) for predicting MS. The odds ratio of this population for experiencing MS due to an EAT ≥ 5 mm was 8.25 (95%CI: 3.15-21.56; P=.0001). CONCLUSION: An EAT value ≥ 5 mm has good sensitivity and specificity for predicting MS in the Venezuelan population.

Hipertiroidismo subclínico exógeno: efecto en el sistema cardiovascular / Exogenous subclinical hyperthyroidism: Effect on the cardiovascular system

Objetivo: Evaluar los efectos del hipertiroidismo subclínico exógeno en la estructura y la función del ventrículo izquierdo. Material y método: Se estudió a 23 pacientes, de ambos sexos, de entre 27 y 70 años, con diagnóstico de hipertiroidismo subclínico exógeno (tirotropina [TSH] sérica, # 0,4 mU/ml, y tiroxina libre [T4l], normal) que habían recibido tratamiento con levotiroxina, a dosis supresora, durante un promedio de 6,7 (1-35) años. Se seleccionó a 20 sujetos con función tiroidea normal, ajustados por edad, sexo e índice de masa corporal, como controles. Se les realizó historia clínica y se cuantificaron las manifestaciones de hipertiroidismo. La estructura y la función del ventrículo izquierdo, así como el tiempo de conducción auricular, se evaluaron mediante un ecocardiograma bidimensional, un eco-Doppler pulsado y tisular con registro electrocardiográfico. Se calculó el índice de compensación hemodinámica de la masa del ventrículo izquierdo. Resultados: La puntuación de las manifestaciones de hipertiroidismo fue significativamente mayor (p = 0,0001) en los pacientes que en los controles. Se obtuvo una correlación positiva de la puntuación de hipertiroidismo con la T4l (p = 0,005) y la fracción de eyección (p = 0,04) y una correlación negativa con las concentraciones de TSH (p = 0,03). El volumen diastólico final, el volumen latido, el gasto cardíaco y el trabajo latido fueron significativamente más altos en los pacientes con hipertiroidismo subclínico (p = 0,04; p = 0,02; p = 0,05, y p = 0,01, respectivamente). Hubo una correlación positiva del acortamiento fraccional con la concentración de T4l (p = 0,022) y la dosis de levotiroxina (p = 0,016) y del trabajo latido con la concentración de T4l (p = 0,034). La masa del ventrículo izquierdo, la función diastólica y el tiempo de conducción auricular no fueron diferentes de los controles. Conclusiones: Nuestros resultados indican que en pacientes con hipertiroidismo subclínico exógeno se producen cambios hemodinámicos adaptativos al efecto biológico de la levotiroxina en el sistema cardiovascular, sin llegar a producirse cambios estructurales (AU)

Objective: To evaluate the effects of exogenous subclinical hyperthyroidism on left ventricular structure and function. Material and method: Twenty-three patients of both sexes, aged 27 to 70 years, with a diagnosis of exogenous subclinical hyperthyroidism (serum thyroid-stimulating hormone [TSH] # 0.4 mU/ml and normal free thyroxine [FT4]) were evaluated. The patients had been taking levothyroxine in suppressive doses for an average of 6.7 years (1 to 35 years). Twenty euthyroid individuals matched for age, sex and body mass index were selected as controls. A medical history was obtained and symptoms of thyrotoxicosis were quantified in all subjects. To evaluate left ventricular structure and function, as well as atrial conduction time, a two-dimensional echocardiogram and pulsed echo and tissue echo Doppler with electrocardiography monitoring were performed. The index of hemodynamic compensation of the left ventricular mass was calculated. Results: Hyperthyroid symptom scores were significantly higher in patients than in controls (p = 0.0001). A positive correlation was found between hyperthyroidism scores and FT4 (p = 0.005) and ejection fraction (p = 0.04) and a negative correlation was found with TSH levels (p = 0.03). End-diastolic volume, stroke volume, cardiac output and stroke work were significantly higher in patients with SH (p = 0.04, p = 0.02, p = 0.05 and p = 0.01, respectively). A positive correlation was found between fractional shortening and FT4 level (p = 0.022) and levothyroxine dose (p = 0.016) and between stroke work and FT4 level (p = 0.034). Left ventricular mass, diastolic function and atrial conduction time were similar in patients and controls. Conclusions: Our study suggests that patients with exogenous subclinical hyperthyroidism have hemodynamic changes resulting from adaptation to the biological effects of levothyroxine on the cardiovascular system. However, structural changes are not produced (AU)

Exogenous subclinical hyperthyroidism: effect on the cardiovascular system.

OBJECTIVE: To evaluate the effects of exogenous subclinical hyperthyroidism on left ventricular structure and function. MATERIAL AND METHOD: Twenty-three patients of both sexes, aged 27 to 70 years, with a diagnosis of exogenous subclinical hyperthyroidism (serum thyroid-stimulating hormone [TSH] ≤ 0.4mU/ml and normal free thyroxine [FT4]) were evaluated. The patients had been taking levothyroxine in suppressive doses for an average of 6.7 years (1 to 35 years). Twenty euthyroid individuals matched for age, sex and body mass index were selected as controls. A medical history was obtained and symptoms of thyrotoxicosis were quantified in all subjects. To evaluate left ventricular structure and function, as well as atrial conduction time, a two-dimensional echocardiogram and pulsed echo and tissue echo Doppler with electrocardiography monitoring were performed. The index of hemodynamic compensation of the left ventricular mass was calculated. RESULTS: Hyperthyroid symptom scores were significantly higher in patients than in controls (p=0.0001). A positive correlation was found between hyperthyroidism scores and FT4 (p=0.005) and ejection fraction (p=0.04) and a negative correlation was found with TSH levels (p=0.03). End-diastolic volume, stroke volume, cardiac output and stroke work were significantly higher in patients with SH (p=0.04, p=0.02, p=0.05 and p=0.01, respectively). A positive correlation was found between fractional shortening and FT4 level (p=0.022) and levothyroxine dose (p=0.016) and between stroke work and FT4 level (p=0.034). Left ventricular mass, diastolic function and atrial conduction time were similar in patients and controls. CONCLUSIONS: Our study suggests that patients with exogenous subclinical hyperthyroidism have hemodynamic changes resulting from adaptation to the biological effects of levothyroxine on the cardiovascular system. However, structural changes are not produced.

Objective quantification of global and regional left ventricular systolic function by endocardial tracking of contrast echocardiographic sequences.

BACKGROUND: Echocardiographic assessment of LV wall motion is still most frequently done visually. This study was designed to validate a new system for semi-automatic quantification of global and regional LV systolic function from contrast-enhanced cross-sectional echocardiograms. METHODS: Measurements of LV volumes were validated in 50 patients using magnetic resonance (MR) as reference. The regional identification of the endocardial boundary was validated frame-by-frame against the visually identified border in another 27 patients. Finally, the applicability of the system for quantifying stress-echocardiographic exams was assessed in 52 patients undergoing dobutamine interventions. Echocardiographic sequences were digitally processed using custom-built algorithms, based on local phase feature descriptors, deformable contour fitting, and prospective training. RESULTS: Compared to MR, the tracing system showed reasonable accuracy, with relative errors for end-diastolic volume, end-systolic volume, and EF of 21+/-20%, 27+/-33%, and--4+/-18%, respectively. Regional agreement of the instantaneous contours with visually traced borders was within the limits of visual reproducibility. The system was suitable for tracking stress-echo studies from all patients except two (96%). Quantification of regional radial shortening allowed to discriminate segments showing an abnormal regional wall motion with an overall area under the ROC curve of 0.87. CONCLUSIONS: A reliable and accurate quantification of LV systolic function can be obtained by processing contrast echocardiograms. Values of LV volumes, ejection fraction, and regional endocardial shortening adequately correlate with currently available reference methods. Readily applicable to baseline and stress studies, endocardial tracking techniques increase the reliability of echocardiography for the assessment of global and regional systolic function.

Patterns of left ventricular hypertrophy in essential hypertension: should echocardiography guide the pharmacological treatment?

The experimental design of clinical studies, on the pharmacological treatment of essential hypertension, has ignored a fundamental issue: Hypertensive patients are not a homogenous population. The adaptation of the cardiovascular system to hypertension is structurally and functionally heterogeneous. Recent clinical investigations suggest that this heterogeneity can be minimized by echocardiography. Thus, when the hemodynamic and neurohormonal profiles of untreated hypertensive patients are considered, in the particular context of the cardiac morphologic adaptation to high blood pressure, distinct common denominators emerge. Concentric and eccentric hypertrophy, the two most common patterns of ventricular hypertrophy, are at the extremes of the geometric spectrum. Concentric hypertrophy is characterized by an elliptic left ventricle, normal stroke volume and high peripheral vascular resistance. Its predominant neurohormonal profile includes elevated plasma renin and natriuretic peptide levels. Conversely, most patients with eccentric hypertrophy have a spheric left ventricle, increased stroke volume and low peripheral vascular resistance. Its corresponding neurohormonal profile shows low serum renin and enhanced sympathetic nervous activity. The therapeutic response, to angiotensin II antagonists and to beta-adrenergic blockers, of these two geometric patterns is also different. Concentric hypertrophy is substantially reversed by losartan, whereas, eccentric hypertrophy is refractory to both, losartan and atenolol. These facts raise a relevant question: Should ventricular geometry be considered when deciding which antihypertensive drug is to be prescribed?

Cambios hemodinamicos precoces en pacientes con resistencia insulínica

Objetivos: Determinar cambios hemodinámicos, estructurales y funcionales de pacientes con resistencia insulínica y sin síndrome metabólico. Métodos: Se seleccionaron diez pacientes de ambos sexos con diagnóstico de resistencia insulínica. Diez pacientes sanos ajustados por edad, sexo e índice de masa corporal (IMC) constituyeron el grupo control. El IMC y la presión arterial fueron registrados. Los pacientes fueron sometidos a una prueba de tolerancia oral a la glucosa. El índice de HOMAIR fue utilizado para el cálculo de la resistencia insulínica (HOMAIR: valor ≥ 2,5). La concentración de norepinefrina plasmática (NE) se cuantifico por HPLC. Los parámetros hemodinámicos, estructurales y funcionales del corazón fueron evaluados mediante el ecocardiograma bidimensional, eco doppler pulsado y doppler pulsado tisular. Resultados: La glucemia, la insulina basal y post-carga y el HOMAIR fueron significativamente más altos en el grupo de pacientes. El índice cardiaco resultó significativamente más bajo en el grupo de pacientes. La concentración de NE se correlacionó en forma positiva y estadísticamente significativa con las concentraciones de insulina basal y post-carga. La presión arterial diastólica se correlacionó en forma negativa y estadísticamente significativa con la insulina post-carga solo en el grupo control. El volumen diastólico final del ventrículo izquierdo se correlacionó en forma positiva y estadísticamente significativa con la insulina y el HOMAIR en el grupo de pacientes pero no en el grupo control. Conclusiones: Los niveles de insulina plasmática podrían desempeñar un papel muy importante en la modulación de los niveles plasmáticos de NE en pacientes con resistencia insulínica. La sobreactivación del sistema nervioso simpático podría condicionar anormalidades en el volumen sistólico final y el índice cardiaco, los cuales constituirían los cambios hemodinámicos adaptativos precoces en pacientes con resistencia insulínica sin síndrome metabólico.

Objective: To determine the haemodynamic, structural and functional changes in insulin-resistant subjects Methods: Ten insulin-resistant subjects were studied. Asymptomatic subjects were studied as a control group. Blood pressure and body mass index were registered. Standard oral glucose tolerance test was performed. Plasma glucose and insulin were measured at baseline and 2 hours post glucose load. Insulin resistance index HOMAIR was calculated. Insulin resistance was considered if HOMAIR value was ≥ 2.5. Plasma norepinephrine (NE) was measured by HPLC. In order to examine the mass and cardiac function, bi-dimensional echocardiogram and imaging doppler tissue were performed. Results: Plasma glucose, insulin and HOMAIR were significantly higher in insulin-resistant subjects. There was no significant difference in plasma NE concentration between groups. The cardiac index was the only haemodynamic variable found to be significantly lowers in insulin resistant subjects. A significant positive correlation between NE with fasting and post load insulin concentration was observed. In control group, a significant negative correlation between diastolic blood pressure and post load insulin concentration was observed. The left ventricle systolic end-volume was positively and significantly correlated with insulin and HOMAIR in insulin-resistant subjects, but not in controls. Conclusions: Insulin levels may play role in modulating plasma NE levels, particularly in insulin-resistant subjects. The increased sympathetic activity in these subjects might lead to an abnormality in the left ventricle systolic end-volume and cardiac index, which might be the earlier adaptative haemodynamic changes due to cardiac post-load.

Mechanisms of neurohormonal activation in chronic congestive heart failure: pathophysiology and therapeutic implications.

Patients with chronic congestive heart failure have a sequential and incessant activation of those neurohormonal systems, which control body fluids, cardiac output and systemic blood pressure. Neurohormonal activation is initially selective and regional. Generalized activation is a late event in the natural history of congestive heart failure. Although the ultimate stimulus responsible for the activation of these neurohormonal systems is unknown, a decreased cardiac output and diminished effective blood volume have been proposed as the responsible mechanisms. However, extensive clinical and experimental research suggest that cardiac remodeling and loading of low-pressure cardiac receptors with sympathetic afferents could be the triggering events followed by unloading of high-pressure carotid receptors by decreased cardiac output and diminished effective blood volume.

Valsalva maneuver in chagasic patients with documented past medical history of acute chagasic myocarditis.

BACKGROUND: We studied the heart rate responses to the Valsalva maneuver in eight patients with documented past medical history of acute Chagas' disease. METHODS: Four patients were studied 8-21 months after the acute episode and four, 58-68 months thereafter (age 25+/-8.65 years M+/-S.D.). Seventeen healthy subjects of similar age were included as controls (age 27+/-7.5 years, P=NS). RESULTS: Baseline heart rate was higher in chagasic patients (88+/-15 beats/min) compared to controls (69.8+/-9.8, P=0.001). Maximum heart rate at phase II of the maneuver was also higher (114+/-16.3 vs. 101.5+/-9.9, P=0.02). Minimum heart rate at phase IV was, however, not different (57.4+/-10.4 vs. 63.3+/-7.3 P=NS). The magnitude of the absolute negative change at phase IV was larger in the chagasic patients, although, not different (-50.8+/-13.8 vs. -44+/-13.8, P=NS). The Valsalva index was 1.81+/-0.26 in the chagasic patients and 1.82+/-0.42 in the controls (P=NS). Minimum heart rate at phase IV correlated neither with the baseline heart rate (r=-0.28, P=NS) nor with the Valsalva index (r=-0.40, P=NS). The magnitude of the absolute negative change during phase IV correlated with, both, the baseline heart rate (r=-0.80, P<0.01) and the Valsalva index (r=-0.95, P<0.0001). The higher baseline high rate influenced the magnitude of the negative heart rate change, but not the minimum heart rate reached at phase IV. CONCLUSIONS: Chagasic patients with proven past medical history of acute Chagas' disease had unimpaired heart responses to the Valsalva maneuver.

Clinical efficacy of Doppler-echocardiographic indices of aortic valve stenosis: a comparative test-based analysis of outcome.

OBJECTIVES: This study was designed to assess which hemodynamic index best accounts for clinical severity of aortic stenosis (AS) and to analyze the value of low-dose dobutamine testing. BACKGROUND: Pressure gradient and valve area are suboptimal because they depend on flow rate, correlate poorly with symptoms, and provide limited prognostic information. Recently, new indices and low-dose inotropic stimulation have been introduced, but their clinical value remains uncertain. METHODS: A total of 307 consecutive patients with AS were included in an ambispective study design (71 +/- 12 years old; peak jet velocity: 3.7 +/- 1.1 m/s). Clinical and Doppler-echocardiographic data were obtained, as well as results of low-dose dobutamine infusion (47 patients). Using receiver-operator-characteristic curve analysis, we evaluated jet velocity, pressure gradient, valve area, resistance, stroke-work loss (SWL), and dobutamine-induced increase in area for predicting 1) symptomatic status at entry, 2) early (25% best discriminated clinical end points. Other independent predictors of prognosis were symptomatic status and left ventricular ejection fraction. Dobutamine testing added no value to baseline models. CONCLUSIONS: Non-flow-corrected indices show the highest clinical efficacy in aortic stenosis. Among these, SWL best predicts symptomatic status and outcome and therefore should be incorporated to aid patient management in unclear situations.