Diagnostic accuracy of bicuspid aortic valve by echocardiography

Abstract

Background Echocardiography is regarded as the gold standard for diagnosis of bicuspid aortic valve (BAV), yet diagnostic accuracy has been evaluated previously only in single‐center studies. We systematically evaluated the accuracy of BAV diagnosis in a large healthcare system of multiple echocardiography laboratories. Methods and Results Aurora Health Care is a multihospital, multi‐clinic system across the state of Wisconsin encompassing 33 inpatient and outpatient echocardiography laboratories with 39 cardiologist readers and 72 sonographers. As all laboratories store echocardiograms in one database, we queried all patients with “bicuspid aortic valve” diagnosis on echocardiography. Echocardiograms were classified as “BAV” or “possible BAV” based on initial reader confidence. An expert review panel categorized each as BAV, no BAV, or Indeterminate. Of the 745 cases identified, 589 (79.1%, initial reader interpretation: n = 494 “BAV,” n = 95 “possible”) were BAV. A high level of agreement (84%) was present in BAV diagnosis. There were 156 (20.9%) echocardiograms that were no BAV (8.4%) or Indeterminate (12.4%). We identified three common reasons for misdiagnosis: poor image quality (n = 70, 44.9%), leaflet calcium (n = 44, 28.2%), and oblique axis imaging (n = 33, 21.1%). A clear reason for misclassification was not elucidated in nine cases (n = 9, 5.7%). Conclusions This is the first study to evaluate BAV accuracy across a community health system with multiple echocardiography laboratories and a heterogeneous group of readers and sonographers. We establish a high degree of accuracy of echocardiography in BAV diagnosis and draw attention to common echocardiographic pitfalls that lead to BAV misclassification, highlighting opportunities for education and quality improvement.

Prevalence of Bicuspid Aortic Valve in Turner Syndrome Patients Receiving Cardiac MRI and CT: A Meta-Analysis

“…The exclusion criteria were the following: (1) the inclusion criteria were not met; (2) the prevalence of BAV in TS patients was neither reported nor possible to calculate nor possible to extrapolate; (3) studies excluding TS patients who underwent cardiac surgery; (4) studies on specific TS karyotypes; (5) studies only containing pregnant TS patients; (6) reviews, meta-analyses, case reports, letters, conference abstracts, or protocols; (7) repeated publication of the same study population.…”

“…Transthoracic echocardiography (TTE) is conventionally used to screen for BAV [7]. However, TS is often accompanied by excess weight and chest wall anomalies, particularly in adult subjects, hampering optimal echocardiographic image quality and thus the diagnosis of BAV [8].…”

Heart Failure Associated With Ventricular Septal Defect, Mitral Valve Prolapse, Non-stenotic Bicuspid Aortic Valve, and Patent Foramen Ovale

“…The patient was advised for repair of the VSD, however, he was lost to follow-up. It is important to stress the frequent echocardiography follow-up from a young age in order to prevent irreversible detrimental effects [12].…”

Serial echocardiography for valve dysfunction and aortic dilation in bicuspid aortic valves

“…Studies of diagnostic accuracy of echocardiography suggest 84% accurate bicuspid valve diagnosis with a single transthoracic echocardiogram, although surgical inspection of the valve remains the gold standard. 25 It remains possible that some cases were actually unicuspid rather than bicuspid aortic valves. 26 The age of presentation may influence the relative proportions of right-non and right-left bicuspid aortic valve morphologies.…”