Aortic valve systolic flutter as a screening test for severe aortic stenosis

Area of Science:

• Cardiology
• Medical Imaging
• Diagnostic Ultrasound

Background:

• Previous M-mode and 2-D echocardiography methods have limitations in differentiating significant aortic stenosis (AS).
• A pliant aortic valve may exhibit systolic flutter, a potential indicator for excluding severe AS.

Purpose of the Study:

• To evaluate the diagnostic utility of M-mode echocardiography-detected aortic valve systolic flutter in identifying significant aortic stenosis (AS).

Main Methods:

• Reviewed M-mode echocardiograms of 50 patients with suspected AS, with 2-D echocardiography in 18.
• Correlated M-mode findings, specifically systolic flutter, with catheterization-derived aortic valve gradients and areas.

Main Results:

• Aortic valve systolic flutter was observed in 19 of 40 (48%) patients with identifiable cusps, associated with low gradients (mean 4 +/- 8 mm Hg) and large valve areas (mean 2.8 +/- 0.4 cm2).
• Absence of flutter in 21 of 40 (52%) patients correlated with high gradients (mean 55 +/- 19 mm Hg) and small valve areas (mean 0.7 +/- 0.3 cm2).
• Systolic flutter was absent when gradients exceeded 30 mm Hg or valve areas were less than 1 cm2.

Conclusions:

• Aortic valve systolic flutter on M-mode echocardiography is a strong negative predictor for significant AS.
• Absence of flutter does not reliably predict AS severity.
• M-mode echocardiography systolic flutter may serve as a valuable screening tool for patients with suspected AS.