BackgroundSimplified projected aortic valve area (EOAproj) is a valuable
echocardiographic parameter in the evaluation of low flow low gradient
aortic stenosis (LFLG AS). Its widespread use in clinical practice is
hampered by the laborious process of flow rate (Q) calculation.ObjetiveThis study proposes a less burdensome, alternative method of Q calculation to
be incorporated in the original formula of EOAproj and measures
the agreement between the new proposed method of EOAproj
calculation and the original one.MethodsRetrospective observational single-institution study that included all
consecutive patients with classic LFLG AS that showed a Q variation with
dobutamine infusion ≥ |15|% by both calculation methods.ResultsTwenty-two consecutive patients with classical LFLG AS who underwent
dobutamine stress echocardiography were included. Nine patients showed a Q
variation with dobutamine infusion calculated by both classical and
alternative methods ≥ |15|% and were selected for further statistical
analysis. Using the Bland-Altman method to assess agreement we found a
systematic bias of 0,037 cm2 (95% CI 0,004 - 0,066), meaning that
on average the new method overestimates the EOAproj in 0,037
cm2 compared to the original method. The 95% limits of
agreement are narrow (from -0,04 cm2 to 0,12 cm2),
meaning that for 95% of individuals, EOAproj calculated by the
new method would be between 0,04 cm2 less to 0,12 cm2
more than the EOAproj calculated by the original equation.ConclusionThe bias and 95% limits of agreement of the new method are narrow and not
clinically relevant, supporting the potential interchangeability of the two
methods of EOAproj calculation. As the new method requires less
additional measurements, it would be easier to implement in clinical
practice, promoting an increase in the use of EOAproj.
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