December 1, 1988
View Full PaperDoppler Echocardiography in Adults With Symptomatic Aortic Stenosis
Structured PICO
Does a Doppler echocardiography-based clinical prediction rule accurately predict the need for aortic valve replacement and reduce costs compared to an invasive diagnostic approach in adults with symptomatic aortic stenosis?
P
Population
103 adults undergoing cardiac catheterization for suspected symptomatic aortic stenosis, mean age 69 years.
I
Intervention
Doppler echocardiography using a clinical prediction rule based on maximum aortic jet velocity (Vmax) and Doppler aortic valve area (AVA).
C
Comparator
Invasive diagnostic approach (cardiac catheterization).
O
Outcome
Need for aortic valve replacement (AVR).
A Doppler echocardiography-based clinical prediction rule accurately identifies the need for aortic valve replacement in symptomatic aortic stenosis, potentially reducing the need for invasive catheterization and lowering diagnostic costs.
Abstract
To evaluate the diagnostic utility and cost-effectiveness of Doppler echocardiography in adults with symptomatic aortic stenosis, we performed a prospective study in which the need for aortic valve replacement (AVR) was the outcome event. The total sample consisted of 103 adults (mean age, 69 years) undergoing cardiac catheterization for suspected aortic stenosis. Twenty-six patients (25%) were used as a training set to develop a clinical prediction rule. (1) If maximum aortic jet velocity (Vmax) was more than 4.0 m/s, AVR was recommended. (2) If Vmax was less than 3.0 m/s, AVR was not needed. (3) If Vmax was 3.0 to 4.0 m/s and (a) Doppler aortic valve area (AVA) was 1.0 cm2 or less, AVR was recommended, while (b) if Doppler AVA was 1.7 cm2 or greater, AVR was not needed, and (c) if Doppler AVA was 1.1 to 1.6 cm2, consideration of the degree of coexisting aortic insufficiency was necessary. When this rule was applied to the test set (n = 77), the sensitivity was 98%, with a specificity of 89% and a total error rate of 3.9%. The approach could have resulted in cost savings between 24% and 34% compared with an invasive diagnostic approach.