Echocardiographic Evaluation of Calcific Aortic Stenosis in the Older Adult

Abstract

Aortic stenosis is the most predominant valvular pathology occurring in older adults with an expected increase over time. Multiple comorbidities and highly variable clinical presentations which characterize the aging population necessitate the use of echocardiography in the assessment of valvular structure and real time hemodynamic evaluation. This article reviews the pathophysiology and clinical presentation of aortic stenosis in this unique population and the critical role of various echocardiographic modalities. The value of real time three-dimensional real time echocardiography in the assessment and management of aortic stenosis in older adults is emphasized.

Value of Two‐Dimensional Speckle Tracking and Real Time Three‐Dimensional Echocardiography for the Identification of Subclinical Left Ventricular Dysfunction in Patients Referred for Routine Echocardiography

“…Resting two‐dimensional (2D) echocardiography is widely used today as a first line screening tool for detection of a wide variety of cardiac diseases such as valvular pathology, pericardial disease, congenital lesions, coronary artery disease (CAD), etc 1–5 . However, the assessment of myocardial dysfunction chiefly relies on wall motion analysis (WMA) and estimation of left ventricular ejection fraction (LV EF) which is subjective and limited by high observer variability 6 …”

Two‐Dimensional Color Doppler Echocardiography for Left Ventricular Stroke Volume Assessment: A Comparison Study with Three‐Dimensional Echocardiography

“…Direct planimetry using 3DE is increasingly popular as this technique enables actual LVOT area to be measured without relying on the assumption of circularity and avoids error induced by squaring the measured LVOT radius 7 . Our group has previously showed that direct planimetry of LVOT area is an accurate and feasible method and correlates extremely well with real time 3D echocardiography (RT3DE) full volume measurements for SV assessment 2 .…”

“…SV determination from LVOT diameter (d) makes several statements, such as (1) the outflow tract has a circular configuration and (2) its dimension remains stable during systole 5 . The major difficulty in assessment of SV by calculating LVOTd is that the diameter is squared in order to determine SV and thus small errors in measuring LVOTa are amplified 5–7 …”

Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis

“…10 Cardiac catheterization allows direct measurement of the left ventricular and proximal aortic pressures and remains the gold standard for evaluation of transvalvular pressure gradient and cardiac output. [11][12][13] Exercise stress testing, although contraindicated in symptomatic patients with aortic stenosis, is recommended in asymptomatic patients. [11][12][13] Exercise stress testing, although contraindicated in symptomatic patients with aortic stenosis, is recommended in asymptomatic patients.…”