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Severe aortic stenosis echocardiographic thresholds revisited

Shmuel Schwartzenberg1, Mordehay Vatury1, Maya Wiessman1

  • 1The Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.

Echocardiography (Mount Kisco, N.Y.)
|December 2, 2021
PubMed

Insights

Aortic valve area (AVA) and Doppler velocity index (DVI) are key indicators for identifying severe aortic stenosis (AS). Thresholds of AVA ≤ 0.81 cm² or DVI ≤ 0.249 effectively predict the need for aortic valve replacement (AVR) or death.

Area of Science:

  • Cardiology
  • Echocardiography
  • Medical Diagnostics

Background:

  • Hemodynamic indices for severe aortic stenosis (AS) lack consistent threshold values.
  • The relative contribution of each variable in classifying AS for aortic valve replacement (AVR) indication is unclear.

Purpose of the Study:

  • To assess the discriminative value and optimal thresholds of hemodynamic parameters for AS classification.
  • To confirm the prognostic value of these parameters for AVR or death.

Main Methods:

  • Included 168 patients with moderate AS undergoing echocardiography.
  • Dichotomized AS types and assessed Aortic Valve Area (AVA), Doppler Velocity Index (DVI), and other hemodynamic parameters for discrimination.
  • Determined optimal thresholds and evaluated dichotomized values for predicting AVR or death.

Main Results:

  • AVA and DVI showed the highest discriminative value (C-statistic .74-.9) for AS classification.
  • Optimal thresholds: AVA ≤ 0.81 cm² and DVI ≤ 0.249, with high sensitivity and specificity.
  • All tested dichotomized variables, except Stroke Volume Index (SVI), independently predicted AVR or death during follow-up.

Conclusions:

  • AVA ≤ 0.81 cm² or DVI ≤ 0.249 thresholds are highly valuable for identifying severe AS.
  • These thresholds possess independent prognostic value, aiding clinical decision-making for patients with aortic stenosis.
Abstract

Keywords:
aortic stenosisaortic valve areamean gradientpeak velocity

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