Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis

Abstract

The criteria for the grading of aortic stenosis are inconsistent in patients with normal systolic LV function. On the basis of AVA, a higher proportion of patients is classified as having severe aortic valve stenosis compared with mean pressure gradient and peak flow velocity. Discrepant grading in these patients may be partly due to reduced stroke volume.

Transcatheter Aortic Valve Implantation (TAVI) for Aortic Stenosis

“…Invasive lV catheter pressure measurements of pressure drop are taken at peak-to-peak intervals and may thus differ slightly from Doppler measurements; invasive catheter aortic valve area is calculated using the gorlin equation. 15 The typical definition of 'severe' aortic stenosis varies according to assessment method as detailed in Table 1. all calculated measures of aortic valve area are subject to measurement error 15,22,23 of the lVoT diameter and Doppler envelope. Finegold et al 22 reported better reproducibility of aVa by ratio of peak Doppler velocity compared to Doppler VTI, but with wide confidence limits of +/-25%.…”

Cardiac imaging in valvular heart disease

“…The AVA (cm 2 ) is calculated by dividing the LV stroke volume by the AV VTI (cm) measured on the spectral Doppler display using continuous-wave Doppler (Figure 1b). Doppler during TTE is usually sufficient in the assessment of AS, but the different methods for grading AS are not always concordant [14]. Measurement of the AVA by planimetry, which is direct tracing of the aortic orifice at its point of maximal opening in mid-systole, is rarely feasible by TTE.…”

Natural Progression of Low-Gradient Severe Aortic Stenosis with Preserved Ejection Fraction

“…Approximately one third of patients sent for echocardiographic evaluation of the severity of AS show a discrepancy in echocardiographic measurements: severe stenosis on the basis of AVA, but non-severe stenosis on the basis of MG, in the presence of a normal LVEF. 11,12 These discrepancies were at first attributed to inaccuracies in echocardiographic measurements and to interobserver variability.In the past few years, increasing data have suggested that patients with normal LVEF in the presence of severe AS as defined by valve area (AVA, <1 cm 2 ) and low valve gradient (MG, <40 mmHg) form a true subgroup. These results appear not to be an anomaly arising from the misreading of echocardiographic measure-…”

“…Approximately one third of patients sent for echocardiographic evaluation of the severity of AS show a discrepancy in echocardiographic measurements: severe stenosis on the basis of AVA, but non-severe stenosis on the basis of MG, in the presence of a normal LVEF. 11,12 These discrepancies were at first attributed to inaccuracies in echocardiographic measurements and to interobserver variability.…”