Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;38(12):2016-2024.
doi: 10.1111/echo.15241. Epub 2021 Dec 1.

Severe aortic stenosis echocardiographic thresholds revisited

Shmuel Schwartzenberg  1 , Mordehay Vatury  1 , Maya Wiessman  1 , Alon Shechter  1 , Olga Morelli  1 , Hadas Ofek  1 , Shirit Kazum  1 , Ran Kornowski  1 , Alexander Sagie  1 , Yaron Shapira  1
Affiliations

Severe aortic stenosis echocardiographic thresholds revisited

Shmuel Schwartzenberg et al. Echocardiography. 2021 Dec.

Abstract

Background: In view of inconsistencies in threshold values of severe aortic stenosis (AS) hemodynamic indices, it is unclear what is the relative contribution of each variable in a binary classification of AS based on aortic valve replacement (AVR) indication. We aimed to assess relative discriminative value and optimal threshold of each constituent hemodynamic parameter for this classification and confirm additional prognostic value.

Methods: Echocardiography studies of 168 patients with ≥ moderate AS were included. AS types were dichotomized into Group-A, comprising moderate and Normal-Flow Low-Gradient (NFLG), and Group-B, comprising High-Gradient(HG), Low Ejection Fraction Low-Flow Low-Gradient(Low EF-LFLG), and Paradoxical Low-Flow Low-Gradient(PLFLG) AS. Aortic valve area (AVA), Doppler velocity index (DVI), peak aortic velocity, mean gradient, stroke volume index and transaortic flow rate(TFR) were assessed for A/B Group discrimination value and optimal thresholds were determined. Dichotomized values were assessed for predictive value for AVR or death.

Results: C-statistic values for binary AS classification was .74-.9 for the tested variables. AVA and DVI featured the highest score, and SVI the lowest one. AVA≤.81 cm2 and DVI≤.249 had 87.6% and 86% respective sensitivity for Group B patients, and a similar specificity of 80.9%. During a mean follow-up of 9.1±10.1 months, each of the tested dichotomized variables except for SVI predicted AVR or death on multivariate analysis.

Conclusion: An AVA value ≤.81 cm2 or a DVI ≤ .249 threshold carry the highest discriminative value for severe AS in patients with aortic stenosis, translating into an independent prognostic value, and can be helpful in making clinical decisions.

Keywords: aortic stenosis; aortic valve area; mean gradient; peak velocity.

PubMed Disclaimer

References

REFERENCES

    1. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739-2791.
    1. Nishimura RA, Otto CM, Bonow RO, et al. 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. J Am Coll Cardiol. 2014;63:e57-185.
    1. Baumgartner H, Hung J, Bermejo J, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2017;30:372-392.
    1. Namasivayam M, He W, Churchill TW, et al. Transvalvular flow rate determines prognostic value of aortic valve area in aortic stenosis. J Am Coll Cardiol. 2020;75:1758-1769.
    1. Sen J, Huynh Q, Stub D, Neil C, Marwick TH. Prognosis of severe low-flow, low-gradient aortic stenosis by stroke volume index and transvalvular flow rate. JACC Cardiovasc Imaging. 2021;14:915-927.

LinkOut - more resources