Title:
Discordant and concordant transthoracic echocardiographic
criteria in the diagnosis of severe aortic stenosis
Objective:
The diagnosis of severe aortic stenosis (AS) in TTE is taken seriously but to
ensure the appropriate clinical response, it requires careful consideration,
particularly when the aortic valve velocity (AV Vmax) is less than agreed cut off
(4ms).
To audit current departmental labelling criteria for severe AS.
Methods:
We assessed 100 consecutive patients labelled, “Severe AS” (05.07 –
22.12/2022).
Parameters examined included LV function, AV area (AVA), AV Vmax, AV mean
gradient, symptoms, AV calcium score, cardiology review, referral for
intervention and outcome.
Results:
60% of patients were male, 40% female (mean age 78.1 and 83.5years), 75%
(n=75) were reviewed by Cardiology and 25%(n=25) are awaiting cardiology
review or not referred because of frailty or death.
28% (n=28) were labelled severe AS by AVA (<1cm2) alone (AV Vmax <4ms),
(discordant group (DG)). 59% (n=59) were labelled by AVA (<1cm2) plus AV
Vmax (>4ms) (concordant group (CG)). 10% (n=10) were labelled by AV Vmax
only. 3 were labelled severe by visual appearances, AVA (1.04, 1.06, 1.1 cm2)
and AV Vmax <4ms. 2/3 patients had calcium score >2000AU.
In the DG, 43% (n=12/28) were symptomatic, 42% (n= 5/12) of these were
referred for intervention (3 AVR, 1 died, 1 turned down by TAVI-MDT).
In the CG, 52% (n=31/59) were symptomatic, 71% (n=22/31) referred and
100% (n = 22/22) underwent intervention.
In the AV Vmax only group 20% (n= 2/10) were symptomatic, 1 is awaiting
review, 1 is too frail.
LV function in the DG was: normal 36% (10/28), mild 32% (9/28), moderate
14% (4/28) and severe 18% (5/28). In the CG: 86% (51/59),2% (1/59),10%
(6/59) and 2% (1/59).
Calcium score was available in 30 patients (DG n=7, CG n=19, AV Vmax n=2,
and the non-fulfilling the criteria patients n=2). The mean score of the DG and
CG were 2079 and 3093 AU.
Conclusions:
In this sample of 100 consecutive patients a label of severe AS triggers a
Cardiology review. Nearly 1/3 (28%) were labelled by AVA alone and 82%
(5/28) were not referred for further intervention. Patients may be denied
important treatment based on a label of severe AS whilst they await review.