Key result
Right parasternal assessment provided significant reclassification of aortic stenosis severity compared to apical view alone, with an average estimated misalignment of 14 ± 16 degrees.
Why the study?
Multiple transducer positions including the right parasternal window are recommended for accurate aortic valve stenosis peak velocity measurement, but remain poorly adopted.
Does right parasternal assessment improve accurate classification of aortic stenosis severity compared to apical view alone in patients with aortic stenosis?
Observational (n=330)
Does right parasternal assessment improve accurate classification of aortic stenosis severity compared to apical view alone in patients with aortic stenosis?
Utilizing the right parasternal window in echocardiography significantly improves the accurate grading of aortic stenosis, potentially saving lives by appropriately reclassifying patients to severe disease who may benefit from valve replacement.
May warrant right parasternal views for AS grading; leaves open prospective validation of outcome impact.
: The need for multiple transducer positions, especially from right parasternal windows, is consistently mentioned in the recommendations for the accurate measurement of peak velocities across a stenotic aortic valve, but yet poorly adopted.We performed a subanalysis of the largest prospective series on the right parasternal acoustic windows in patients with aortic stenosis (330 consecutive) to calculate the degree of misalignment and estimate the potential outcome implication of this often-forgotten approach.The right parasternal view was highly feasible with an average estimated misalignment from the apical view of 14 ± 16 degree; in 10 cases, an estimated misalignment >40 degree. Right parasternal assessment (vs. apical alone) provided a significant reclassification from moderate to severe or even very-severe aortic valve stenosis. Considering a wellestablished survival benefit provided by either percutaneous or surgical valve replacement in patients with severe aortic stenosis the reclassification would result in approximately 1 life-year saved for every 30-35 patients in whom parasternal view were effectively utilized.
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Benfari et al. (2020) conducted an observational in aortic valve stenosis (n=330). Right parasternal assessment vs. Apical view alone was evaluated on Degree of misalignment from the apical view. Right parasternal assessment provided significant reclassification of aortic stenosis severity compared to apical view alone, with an average estimated misalignment of 14 ± 16 degrees.
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