Characterisation of aortic stenosis severity: a retrospective analysis of echocardiography reports in a clinical laboratory

Abstract

ObjectiveTo evaluate how common echocardiographic metrics of aortic stenosis (AS) influence the proportion of patients who may be categorised as having severe stenosis and therefore considered for valve replacement.MethodsRetrospective analysis was performed of all echocardiograms with aortic valve area (AVA) ≤1.2 cm2 and peak jet velocity (Vmax) ≥3 m/s from 1 December 2014 through 30 October 2017 at a single academic medical centre. Echocardiographic indices collected include AVA, Vmax, left ventricular ejection fraction, stroke volume and annotated aortic stenosis severity.ResultsAmong 807 patients with AVA ≤1.2 cm2 and Vmax ≥3 m/s (44.0% female, median age 74 years (IQR: 66–81)), 45.6% had Vmax ≥4 m/s, while 75.8% had AVA ≤1 cm2. 40.0% of patients had concordant indices (Vmax ≥4 m/s and AVA ≤1 cm2), and 35.8% had discordant indices (Vmax <4 m/s and AVA ≤1 cm2) of severe AS. Compared with those with concordant indices, patients with discordant indices were more commonly female (54.0% vs 44.3%, p<0.05) and less commonly characterised as severe (42.6% vs 93.8%, p<0.001). Patients with paradoxical low-flow, low-gradient severe AS by echocardiography were disproportionately female (61.5% vs 41.8%, p<0.001), and their disease was characterised as severe only 49.5% of the time.ConclusionsPatients with discordant indices, who are disproportionately female, are commonly described in clinical echocardiography reports as having less than severe AS. Given the potential benefit of AVR in patients with AVA ≤1 cm2 regardless of Vmax, this could have important clinical implications.

Genes That Escape X Chromosome Inactivation Modulate Sex Differences in Valve Myofibroblasts

“…replacements. 6 Pathologically, computed tomographic imaging and echocardiography studies confirmed that women have lower calcification and more fibrous collagen in aortic valves relative to men with equivalent hemodynamic disease severity, 3,4,7,8 suggesting a sexually dimorphic valve stiffening process. 2 Although ≈12.4% of patients >75 years of age develop AVS, 9 there are no effective biomolecular treatments to slow or halt AVS progression in patients of either sex.…”

Severe aortic stenosis echocardiographic thresholds revisited

“…In recent years, new categories of AS subtypes have emerged on the basis of different combinations of these echocardiography‐derived hemodynamic parameters: severe AS with high‐gradient (HG), low‐EF low‐flow low‐gradient (Low EF LFLG), paradoxical low‐flow low‐gradient (PLFLG), and normal‐flow low‐gradient (NFLG). Discordant hemodynamic parameters consisting of a small aortic valve area (AVA) associated with low gradients, are present in up to 40% of patients, 6–14 yielding uncertainty regarding the severity of AS and benefit to be derived from surgical or transcatheter aortic valve replacement (AVR) and sowing uncertainty in the optimal definition of severe AS 15 …”