Accuracy of Two-Dimensional Echocardiography in Determining Aortic Valve Structure in Patients &gt;50 Years of Age Having Aortic Valve Replacement for Aortic Stenosis

Ayad, Ramy F.; Grayburn, Paul A.; Ko, Jong Mi; Filardo, Giovanni; Roberts, William C.

doi:10.1016/j.amjcard.2011.09.006

Cited by 31 publications

(14 citation statements)

References 9 publications

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“…30 We have provided some clarity on methods for reporting and analysing inconclusive index test results in diagnostic accuracy studies. To facilitate this, we firstly differentiated between inconclusive results that are invalid (that is, the key diagnostic feature is uninterpretable or the actual result is missing) and those that are valid (that is, where an adequate test result has been obtained, but the result is not clearly positive or negative).…”

Section: Types Of Inconclusive Test Resultsmentioning

confidence: 99%

Diagnostic accuracy studies: how to report and analyse inconclusive test results

Shinkins

Thompson

Mallett

et al. 2013

BMJ

109

120

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Failure to report inconclusive test results can lead to misleading conclusions regarding the accuracy and clinical usefulness of a diagnostic tool. We show that these results are often overlooked in research on test accuracy and provide guidance on suitable approaches to reporting and analysing these problematic results. The results of studies on diagnostic test accuracy are often reported as a 2×2 classification matrix, in which test results are presented as a dichotomy and a reference standard is used to categorise individuals as with or without disease. This facilitates the calculation of many popular statistics used to summarise the discriminatory performance of tests (such as sensitivity and specificity, positive and negative likelihood ratios, and positive and negative predictive values). Restricting test results to be either positive or negative, however, fails to represent the reality of how they are used in clinical practice 1 ; in many cases, the results from a given diagnostic test do not exclusively fall into these "positive" and "negative" categories. Bethany ShinkinsAlthough most test results provide useful information for diagnostic decision making, there is often a subset of results that are relatively uninformative and lead to an "inconclusive" diagnostic outcome. For example, the "normal" range on a standard biomarker is typically based on statistics that try to minimise the number of false classifications. As most biomarkers are far from perfect discriminators, however, results that fall close to the lower and upper limits of "normality" provide minimal information about the disease status of the patient and are therefore "inconclusive." In most cases inconclusive test results require extra attention from clinicians, such as repeating the test or using more costly (in terms of invasiveness, time, and expense) diagnostic tools. All of these outcomes, coupled with the inevitable delay in diagnosis and clinical decision making, directly affect patient care.In this paper we have focused on clinical scenarios in which there are two disease categories-disease present and disease absent-and discuss the reporting and analysis of inconclusive results produced by a single index test-that is, the diagnostic test under evaluation. Although this is a common scenario in research on diagnostic test accuracy, this is often a simplification of the actual clinical question. In practice, diagnostic tests are often used to distinguish between multiple diseases or different levels of severity, such as different staging in diagnosis of cancer. Additionally, the diagnostic process might involve a pathway of multiple tests rather than a single test. Inconsistent reporting of inconclusive test results in research on diagnostic accuracyWe wanted to explore whether inconclusive results are consistently reported in diagnostic accuracy research. The STARD (STAndards for the Reporting of Diagnostic accuracy studies) statement-a reporting guideline encouraging high quality reporting of diagnostic accuracy studies-recommends...

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Section: Types Of Inconclusive Test Resultsmentioning

confidence: 99%

Diagnostic accuracy studies: how to report and analyse inconclusive test results

Shinkins

Thompson

Mallett

et al. 2013

BMJ

109

120

View full text Add to dashboard Cite

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“…Determination of the number of valve leaflets is more problematic once significant calcification is present. 9 Rheumatic AS is distinguished by commissural fusion and mitral valve involvement.…”

Section: Diagnosismentioning

confidence: 99%

Current Management of Calcific Aortic Stenosis

Lindman

Bonow

Otto

2013

Circulation Research

149

105

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Calcific aortic stenosis (AS) is a progressive disease with no effective medical therapy that ultimately requires aortic valve replacement (AVR) for severe valve obstruction. Echocardiography is the primary diagnostic approach to define valve anatomy, measure AS severity and evaluate the left ventricular (LV) response to chronic pressure overload. In asymptomatic patients, markers of disease progression include the degree of leaflet calcification, hemodynamic severity of stenosis, adverse LV remodeling, reduced LV longitudinal strain, myocardial fibrosis and pulmonary hypertension. The onset of symptoms portends a predictably high mortality rate unless AVR is performed. In symptomatic patients, AVR improves symptoms, improves survival and, in patients with LV dysfunction, improves systolic function. Poor outcomes after AVR are associated with low-flow low-gradient AS, severe ventricular fibrosis, oxygen dependent lung disease, frailty, advanced renal dysfunction and a high comorbidity score. However, in most patients with severe symptoms, AVR is lifesaving. Bioprosthetic valves are recommended for patients over the age of 65 years. Transcatheter AVR is now available for patients with severe comorbidities, is recommended in patients who are deemed inoperable and is a reasonable alternative to surgical AVR in high risk patients.

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“…Transthoracic echocardiography has a high sensitivity for detecting BAV (92%) whereas transoesophageal echo detects nearly 100% of lesions 14. Echo can also characterise the function and morphology of the valve, detect calcification and assess the aortic root, ascending aorta arch and descending thoracic aorta (for coarctation).…”

Section: Valve Lesionsmentioning

confidence: 99%

Valvular heart disease and the military patient

et al. 2015

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Valvular heart disease refers to all inherited and acquired abnormalities impairing the function of one or more of the four cardiac valves. Pathology may be of the valve leaflets themselves, of the subvalvular apparatus or of the annulus or other surrounding structures that influences valve function. This paper examines the most common valve lesions, with specific reference to a military population; it focuses on detection and initial management of valve disease in a young adult population and specifically describes how the diagnosis and treatment of valve disease impacts military medical grading.

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Accuracy of Two-Dimensional Echocardiography in Determining Aortic Valve Structure in Patients >50 Years of Age Having Aortic Valve Replacement for Aortic Stenosis

Cited by 31 publications

References 9 publications

Diagnostic accuracy studies: how to report and analyse inconclusive test results

Diagnostic accuracy studies: how to report and analyse inconclusive test results

Current Management of Calcific Aortic Stenosis

Valvular heart disease and the military patient

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