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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
Summary
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.
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