Aortic valve systolic flutter as a screening test for severe aortic stenosis

Abstract

Previous efforts using M-mode echocardiography or 2-dimensional (2-D) echocardiography have not consistently separated patients with and without significant aortic stenosis (AS). We postulated that an aortic valve sufficiently pliant to produce systolic flutter on M-mode echocardiography could exclude significant AS and reviewed the M-mode echocardiograms of 50 consecutive patients (mean age 59 years) catheterized for presumed AS; 2-D echocardiography was also performed in 18 of 50 patients (36%). In 40 of 50 patients (80%) the aortic valve cusps were easily identified on M-mode echocardiography: 19 of 40 (48%) had systolic flutter with a mean aortic valve gradient of 4 +/- 8 mm Hg (mean +/- standard deviation [SD]) and an aortic valve area of 2.8 +/- 0.4 cm2; 21 of 40 (52%) had no systolic flutter with a mean aortic valve gradient of 55 +/- 19 mm Hg and an aortic valve area of 0.7 +/- 0.3 cm2. In the 10 of 50 patients (20%) in whom aortic valve cusps were not clearly identified, the mean aortic valve gradient was 50 +/- 24 mm Hg and the aortic valve area 0.8 +/- 0.4 cm2. Systolic flutter was not seen with an aortic valve gradient greater than 30 mm Hg or an aortic valve area less than 1 cm2. Aortic valve systolic opening by M-mode echocardiography or 2-D echocardiography did not accurately predict the severity of AS. Thus, aortic valve systolic flutter seen on M-mode echocardiography is strong evidence against significant AS, but the absence of systolic flutter does not allow reliable prediction of the severity of AS. The finding of systolic flutter by M-mode echocardiography may be a useful screening test in patients presumed to have AS.