January 24, 2013Heart
Inconsistent echocardiographic grading of aortic stenosis: is the left ventricular outflow tract important?
Why the study?
Does left ventricular outflow tract diameter affect the consistency of echocardiographic severity grading of aortic stenosis in patients with normal EF?
Population
9,488 patients with aortic stenosis, left ventricular EF ≥50%, mean gradient ≥20 mm Hg, aortic valve area…
Comparison
Stratification by left ventricular outflow tract… vs Comparison across the three LVOTd groups.
Design
Cross-sectional
Authors
Discussion
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Implication
LVOTd variation risks inconsistent AS grading by AVA; hypothesis-generating for adjusted cutoffs pending prospective validation.
Key Points
- This study aims to analyze how left ventricular outflow tract diameter influences inconsistencies in echocardiographic grading of aortic stenosis severity.
- Retrospective echocardiographic cross-sectional analysis from 2000 to 2010
- Patients categorized by left ventricular outflow tract diameter: small, average, and large
- Assessment of severity classification inconsistencies and exploration of alternative aortic valve area thresholds.
- Small LVOTd patients classified as severe had an aortic valve area range of 0.88 to 1.25 cm(2) (p <0.001)
- Lower aortic valve area cut-offs (0.8 cm(2) and 0.9 cm(2)) reduced severe aortic stenosis inconsistencies in small and average LVOTd patients, respectively
- Current aortic valve area cut-off of 1 cm(2) remained consistent for large LVOTd patients.
Structured PICO
Does left ventricular outflow tract diameter affect the consistency of echocardiographic severity grading of aortic stenosis in patients with normal EF?
P
Population
9,488 patients with aortic stenosis (AS), left ventricular EF ≥50%, mean gradient (MG) ≥20 mm Hg, aortic valve area (AVA) ≤2.5 cm², and <moderate (2+) aortic regurgitation.
I
Intervention
Stratification by left ventricular outflow tract diameter (LVOTd) into 'small' (1.7-1.9 cm), 'average' (2.0-2.2 cm), and 'large' (≥2.3 cm) groups.
C
Comparator
Comparison across the three LVOTd groups.
O
Outcome
Inconsistency of data for classification of severity of AS and exploration of alternative thresholds.surrogate
The LVOT diameter is associated with significant inconsistencies in AS assessment by current guidelines, suggesting that lower AVA cut-offs should be considered for patients with average or small LVOTd.
Cite This Study
Michelena et al. (2013) studied this question.