Noninvasive evaluation of the severity of aortic stenosis in adult patients

To determine if a combination of noninvasive variables would be useful in the prediction of the severity of isolated aortic stenosis (AS), 53 patients (mean age 63.4 = 11 years) were evaluated by the following criteria: (1) aortic valve calcification in the plain chest x-ray film; (2) left ventricular hypertrophy by ECG and M-mode echocardiography; (3) faint or absent aortic closure sound; (4) timing of the peak of the systolic murmur; (5) half rise time (T time) of the carotid pulse; and (6) ejection time index. A numeric scoring system and a logistic regression model employing these variables were developed. The total maximum score was 16 points. Sensitivity and specificity for each variable were determined. Patients with clinically evident coronary artery disease (CAD) and significant aortic regurgitation were excluded. All patients underwent hemodynamic studies and coronary arteriography. Thirty-two patients had severe AS (aortic valve area less than 0.75 cm2) and 21 had mild to moderate AS (aortic valve area greater than 0.75 cm2). Significant CAD (greater than or equal to 50% reduction in luminal diameter) was present in 55% of patients. A total score of greater than or equal to 5 occurred in 59% (19 of 32) of patients with severe AS compared to 5% (1 of 21) of patients with mild AS. The presence of subclinical CAD moderately reduced the accuracy of the scoring system principally by its effect upon the timing of the systolic murmur and the ejection time. Combining the scoring system with the presence or absence of symptoms improved the identification of severe AS in patients with a low score.(ABSTRACT TRUNCATED AT 250 WORDS)