Characterisation of aortic stenosis severity: a retrospective analysis of echocardiography reports in a clinical laboratory
Year: 2020
Type: article
Study design: Observational Study
Abstract: Objective To evaluate how common echocardiographic metrics of aortic stenosis (AS) influence the proportion of patients who may be categorised as having severe stenosis and therefore considered for valve replacement. Methods Retrospective analysis was performed of all echocardiograms with aortic valve area (AVA) ≤1.2 cm2 and peak jet velocity (Vmax) ≥3 m/s from 1 December 2014 through 30 October 2017 at a single academic medical centre. Echocardiographic indices collected include AVA, Vmax, left ventricular ejection fraction, stroke volume and annotated aortic stenosis severity. Results Among 807 patients with AVA ≤1.2 cm2 and Vmax ≥3 m/s (44.0% female, median age 74 years (IQR: 66–81)), 45.6% had Vmax ≥4 m/s, while 75.8% had AVA ≤1 cm2. 40.0% of patients had concordant indices (Vmax ≥4 m/s and AVA ≤1 cm2), and 35.8% had discordant indices (Vmax <4 m/s and AVA ≤1 cm2) of severe AS. Compared with those with concordant indices, patients with discordant indices were more commonly female (54.0% vs 44.3%, p<0.05) and less commonly characterised as severe (42.6% vs 93.8%, p<0.001). Patients with paradoxical low-flow, low-gradient severe AS by echocardiography were disproportionately female (61.5% vs 41.8%, p<0.001), and their disease was characterised as severe only 49.5% of the time. Conclusions Patients with discordant indices, who are disproportionately female, are commonly described in clinical echocardiography reports as having less than severe AS. Given the potential benefit of AVR in patients with AVA ≤1 cm2 regardless of Vmax, this could have important clinical implications.
Source: Open Heart
Institutions: Vanderbilt University, Vanderbilt University Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,391
Awards: G1531600799, Mechanobiology of Cardiopulmonary Fibrosis, G2141991604, G2615776415, G364208108, Medical Scientist Training Program, Automated Storage and Retrieval of Biological Systems, The Vanderbilt Institute for Clinical and Translational Research (VICTR) UL1, Immune cells and STAT3-mediated inflammation in calcific aortic valve disease, The Vanderbilt Institute for Clinical and Translational Research (VICTR), G807282068, Medical Scientist Training Program, G95160140
OpenAlex ID: W3062601624