Value of noninvasive testing in adults with suspected aortic stenosis

To determine the predictors of surgically correctable aortic stenosis in patients with systolic murmurs, 231 patients were evaluated. Five variables (carotid upstroke timing, carotid upstroke volume, aortic valve calcification on chest radiography, single or absent second heart sound, and a murmur with its maximal intensity at the right upper sternal border) were significant multivariate correlates. Two echocardiographic factors (a maximal aortic valve leaflet separation of 7 mm or less and hypertrophy of the posterior wall of the left ventricle to 12 mm or more) and one systolic time interval factor (a rate-corrected ejection time of more than 340 msec) added significant incremental information. When prospectively tested on an independent set of 86 patients with suspected aortic outflow obstruction, the combined clinical and noninvasive information correctly placed 10 patients (12 percent) into a low-risk group in which catheterization may not be indicated and 15 patients (17 percent) into a high-risk group in which it might be avoided or limited to coronary arteriography. This approach to predicting aortic stenosis deserves wider prospective testing.