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Doppler-detected valve movement in aortic stenosis: a predictor of adverse outcome
Xiushui Ren1, Nader M Banki, Richard E Shaw
1Cardiology Department, Kaiser Permanente Medical Center, Redwood City, California; Cardiology Department, California Pacific Medical Center, San Francisco, California.
Insights
The absence of aortic valve opening (Aop) or closing (Acl) Doppler signals indicates severe aortic stenosis. This finding is highly specific and predicts a greater need for aortic valve replacement.
Area of Science:
- Cardiology
- Echocardiography
- Valvular Heart Disease
Background:
- The absence of the aortic valve closure sound can indicate severe aortic stenosis.
- Doppler-derived aortic opening (Aop) or closing (Acl) signals may signify advanced severe aortic stenosis.
Purpose of the Study:
- To determine if absent Doppler-detected Aop or Acl transients indicate very severe aortic stenosis.
- To assess the association of absent Aop or Acl with adverse outcomes.
Main Methods:
- 118 patients with moderate or severe aortic stenosis were analyzed.
- Continuous-wave Doppler was used to identify Aop and Acl signals in a blinded manner.
- Statistical comparisons were made between patients with and without Aop/Acl signals.
Main Results:
- Aop or Acl signals were absent in 22 of 118 patients.
- Absence of Aop/Acl correlated with echocardiographic signs of severe aortic stenosis.
- Patients lacking Aop/Acl showed a significantly higher rate of aortic valve replacement (36.4% vs 7.3%).
Conclusions:
- Approximately 1 in 6 patients with aortic stenosis lack detectable Aop or Acl Doppler signals.
- The absence of Aop or Acl is a specific indicator of severe aortic stenosis.
- This absence is strongly associated with the need for aortic valve replacement.
Background:
The absence of auscultatory aortic valve closure sound is associated with severe aortic stenosis. The absence of Doppler-derived aortic opening (Aop ) or closing (Acl ) may be a sign of advanced severe aortic stenosis.
Hypothesis:
Absent Doppler-detected Aop or Acl transient is indicative of very severe aortic stenosis and is associated with adverse outcome.
Methods:
A total of 118 consecutive patients with moderate (n = 63) or severe aortic stenosis (n = 55) were included. Aop and Acl signals were identified in a blinded fashion by continuous-wave Doppler. Patients with and without Aop and Acl were compared using χ(2) test for dichotomous variables and analysis of variance for continuous variables. The associations of Aop and Acl with aortic valve replacement were determined.
Results:
Aop or Acl were absent in 22 of 118 patients. The absence of Aop or Acl was associated with echocardiographic parameters of severe aortic stenosis. The absence of Aop or Acl was associated with incident aortic valve replacement (36.4% vs 7.3%, respectively, P < 0.001). Even in patients with aortic valve area <1 cm(2) , the absence of Aop or Acl was still associated with increased rate of aortic valve replacement (42.1% vs 13.9%, respectively, P = 0.019) and provided incremental predictive value over peak velocity.
Conclusions:
In a typical population of patients with aortic stenosis, approximately 1 in 6 has no detectible aortic valve opening or closing Doppler signal. The absence of an Aop or Acl signal is a highly specific sign of severe aortic stenosis and is associated with incident aortic valve replacement.
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