Doppler echocardiography detected significant aortic stenosis in 20% of elderly patients with ejection systolic murmurs, whereas clinical assessment had a sensitivity of only 44%.
Cross-Sectional (n=39)
Does Doppler echocardiography accurately detect significant aortic stenosis in elderly patients with ejection systolic murmurs compared to clinical assessment?
Doppler echocardiography is necessary to accurately detect significant aortic stenosis in elderly patients with ejection systolic murmurs, as clinical assessment and 2-D echocardiography are insufficiently sensitive.
Thirty-nine elderly patients, mean age 77 years (range 65 to 96), with ejection systolic murmurs were studied to evaluate the functional significance of these murmurs. Subjects were evaluated clinically, by 2-D echocardiography, and by a full Doppler echocardiography study. Good quality Doppler signals were obtained in 35 subjects. Mitral regurgitation was found to be the only significant valvular lesion in 6 patients (17%). Doppler gradients in systole across the aortic valve were less than 30 mmHg in 28 subjects (80%) and were considered not significant. Gradients of greater than 30 mmHg representing significant aortic stenosis were found in 7 subjects (20%). The clinical sensitivity in detecting significant aortic stenosis was 44% and specificity was 81%. Doppler evidence of significant aortic stenosis was found in a substantial proportion of these elderly subjects. Neither clinical assessment nor 2-D echocardiography can be relied on to exclude this condition.
McKillop et al. (Sun,) conducted a cross-sectional in Ejection systolic murmurs (n=39). Doppler echocardiography vs. Clinical assessment and 2-D echocardiography was evaluated on Significant aortic stenosis (Doppler gradient > 30 mmHg). Doppler echocardiography detected significant aortic stenosis in 20% of elderly patients with ejection systolic murmurs, whereas clinical assessment had a sensitivity of only 44%.
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