Objective To evaluate how common echocardiographic metrics of aortic stenosis (AS) influence the proportion of patients who may be categorised as having severe stenosis and therefore considered for valve replacement.
Methods Retrospective analysis was performed of all echocardiograms with aortic valve area (AVA) ≤1.2 cm2 and peak jet velocity (Vmax) ≥3 m/s from 1 December 2014 through 30 October 2017 at a single academic medical centre. Echocardiographic indices collected include AVA, Vmax, left ventricular ejection fraction, stroke volume and annotated aortic stenosis severity.
Results Among 807 patients with AVA ≤1.2 cm2 and Vmax ≥3 m/s (44.0% female, median age 74 years (IQR: 66–81)), 45.6% had Vmax ≥4 m/s, while 75.8% had AVA ≤1 cm2. 40.0% of patients had concordant indices (Vmax ≥4 m/s and AVA ≤1 cm2), and 35.8% had discordant indices (Vmax <4 m/s and AVA ≤1 cm2) of severe AS. Compared with those with concordant indices, patients with discordant indices were more commonly female (54.0% vs 44.3%, p<0.05) and less commonly characterised as severe (42.6% vs 93.8%, p<0.001). Patients with paradoxical low-flow, low-gradient severe AS by echocardiography were disproportionately female (61.5% vs 41.8%, p<0.001), and their disease was characterised as severe only 49.5% of the time.
Conclusions Patients with discordant indices, who are disproportionately female, are commonly described in clinical echocardiography reports as having less than severe AS. Given the potential benefit of AVR in patients with AVA ≤1 cm2 regardless of Vmax, this could have important clinical implications.
- aortic valve disease
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
Statistics from Altmetric.com
Twitter @MichaelR21, @merrymanlab
Contributors Study conception and design: MAR, BRL and WDM. Acquisition and technical analysis of the data: MAR, EF and QSW. Data interpretation: MAR, HMG, BRL and WDM. Manuscript preparation: MAR, HMG, BRL and WDM.
Funding This work was funded by the NIH (R35-HL135790, F30-HL147464 and T32-GM007347) and Fondation Leducq. The data sets used for the analyses described were obtained from Vanderbilt University Medical Center’s BioVU and Synthetic Derivative, which are supported by numerous sources: institutional funding, private agencies and federal grants. These include the NIH-funded Shared Instrumentation grant S10RR025141, and CTSA grants UL1TR002243, UL1TR000445 and UL1RR024975. The views expressed are those of the authors and not necessarily those of the National Institutes of Health, Fondation Leducq, Vanderbilt University or Vanderbilt University Medical Center.
Competing interests BRL has received research grants from Edwards Lifesciences and Roche Diagnostics; served on scientific advisory boards for Roche Diagnostics and has been a consultant to Medtronic and Roche Diagnostics.
Patient consent for publication Not required.
Ethics approval Use of the Synthetic Derivative is classified as non-human research by Vanderbilt University’s Institutional Review Board (IRB), and approval was given for this study (IRB #180320).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Deidentified data are available upon reasonable request by contacting firstname.lastname@example.org.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.