Key result
Adding the right parasternal view to apical evaluation increases very severe AS detection by ~67%.
Why the study?
Although multiplanar Doppler evaluation is recommended for assessing aortic stenosis severity with transthoracic echocardiography, evidence on the diagnostic significance of non-apical methods remains limited.
Does adding the right parasternal view to the apical method improve the assessment of aortic stenosis severity in patients with severe AS?
Observational (n=276)
Does adding the right parasternal view to the apical method improve the assessment of aortic stenosis severity in patients with severe AS?
Answers are grounded in this paper and cite their sources.
Adding the right parasternal view to the standard apical view during echocardiography reduces the underestimation of aortic stenosis severity, reclassifying approximately 10% of cases.
Background Although Doppler evaluation using a multiplanar method is recommended to assess the severity of aortic stenosis (AS) with transthoracic echocardiography, evidence on the diagnostic significance of a non‐apical method is limited. This study aimed to compare the use of the apical with the use of the right parasternal view (RPV) method to evaluate AS severity and to examine the diagnostic significance of performing the RPV method in addition to the apical method during the evaluation. Methods This retrospective observational study included 276 consecutive patients (mean age: 79 ± 10 years; women, 56%) with severe AS (aortic valve area [AVA] ≤1.0cm 2 ). The severity of AS according to the apical method and that according to the RPV for all subjects were compared, and the significance of performing the RPV method in addition to the apical method was examined. Furthermore, we compared the concordance group, in which the apical and RPV methods indicated matching in severity, and the discordant group, in which the apical and RPV methods did not indicate matching severity. Results Peak velocity ( V max ), mean pressure gradient (MG) were significantly higher and the AVA, AVAi, and Doppler velocity index (DVI) were significantly smaller when the RPV was added to the apical view. Performing the RPV method in addition to the apical method significantly decreased the number of low PG AS cases (MG < 40 mmHg) from 69.9% to 65.0% and it increased the number of very severe AS cases ( V max ≥ 5 m/s) from 8.7% to 14.5%. Deviation of Doppler angle was significantly greater in the discordant group compared to the concordant group (22.5 ± .6 vs. 31.8 ± 1.7, p < .001). Conclusions By performing the RPV method in addition to the apical method to determine AS severity, the diagnosis of AS to be resolved in approximately 10% of cases. These results suggest that AS severity may be underestimated by using the apical method alone.
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Shimamura et al. (2022) conducted an observational in Severe aortic stenosis (n=276). Right parasternal view (RPV) method in addition to apical method vs. Apical method alone was evaluated on Detection of very severe AS cases (Vmax ≥ 5 m/s). Adding the right parasternal view to the apical method for evaluating aortic stenosis severity increased the detection of very severe AS cases from 8.7% to 14.5%.
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