ABC | Volume 110, Nº2, February 2018

Original Article Ferreira et al Alternative method to calculate simplified EOA proj Arq Bras Cardiol. 2018; 110(2):132-139 1. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, et al; ACC/AHA Task Force Members. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(23):e521- 643. doi: 10.1161/CIR.0000000000000031. Erratum in: Circulation. 2014;130(13):e120. 2. Awtry E, Davidoff R. Low-flow/low-gradient aortic stenosis. Circulation. 2011;124(23):e739-41. doi: 10.1161/CIRCULATIONAHA.111.075853. 3. Garnier F, Eicher JC, Jazayeri S, Bertaux G, Bouchot O, Aho LS, et al. Usefulness and limitations of contractile reserve evaluation in patients with low-flow, low-gradient aortic stenosis eligible for cardiac resynchronization therapy. Eur J Heart Fail. 2014;16(6):648-54. doi: 10.1002/ejhf.78. 4. Blais C, Burwash IG, Mundigler G, Dumesnil JG, Loho N, Rader F, et al. Projected valve area at normal flow rate improves the assessment of stenosis severity inpatientswith low-flow, low-gradientaorticstenosis:themulticenter TOPAS (Truly or Pseudo-Severe Aortic Stenosis) study. Circulation. 2006;113(5):711-21. doi: 10.1161/CIRCULATIONAHA.105.557678. 5. Quiñones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA; Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Recommendations for quantification of Doppler echocardiography: A report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiogr. 2002;15(2):167-84. PMID: 11836492. 6. Bland JM, AltmanDG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1(8476):307-10. PMID: 2868172. 7. ClavelMA,FuchsC,BurwashIG,MundiglerG,DumesnilJG,BaumgartnerH, et al. Predictors of outcomes in low-flow, low-gradient aortic stenosis: results of themulticenter TOPAS Study. Circulation. 2008;118(14 Suppl):S234-42. doi: 10.1161/CIRCULATIONAHA.107.757427. 8. Clavel MA, Burwash IG, Mundigler G, Dumesnil JG, Baumgartner H, Bergler-Klein J, et al. Validation of conventional and simplified methods to calculate projected valve area at normal flow rate in patients with low flow, low gradient aortic stenosis: the multicenter TOPAS (True or Pseudo Severe Aortic Stenosis) study. J Am Soc Echocardiogr. 2010;23(4):380-6. doi: 10.1016/j.echo.2010.02.002. 9. GiavarinaD. Understanding Bland Altman analysis. BiochemMed (Zagreb). 2015;25(2):141-51. doi: 10.11613/BM.2015.015 10. Bunce C. Correlation, agreement, and Bland-Altman analysis: statistical analysis of method comparison studies. Am J Ophthalmol. 2009;148(1):4-6. doi: 10.1016/j.ajo.2008.09.032. References both methods in clinical practice. As the new method requires less additional measurements, it would be easier to implement it in clinical practice, promoting an increase in the use of EOA proj - a valuable echocardiographic parameter in the evaluation of LFLG AS. Limitations This is a small retrospective single-institution study that is inherently underpowered to assess small differences in echocardiographic variables between groups. A higher number of patients is needed to investigate potential discrepancies in the performance of both EOA proj calculation methods in different subsets of LFLG AS patients. Therefore, the results presented here must be interpreted with caution. Author contributions Conception and design of the research: Ferreira JSSM, Moreira N, Ferreira R, Martins R; Acquisition of data: Ferreira JSSM, Moreira N, Mendes S; Analysis and interpretation of the data: Ferreira JSSM, Moreira N, Ferreira R, Martins R, Ferreira MJ; Statistical analysis: Ferreira JSSM, Ferreira R; Writing of the manuscript: Ferreira JSSM, Moreira N, Ferreira R, Mendes S, Martins R; Critical revision of the manuscript for intellectual content: Ferreira JSSM, Moreira N, Ferreira R, Mendes S, Martins R, Ferreira MJ, Pego M. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the Faculdade de Medicina da Universidade de Coimbra under the protocol number CE-016/2017. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 138