Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis.

Full Abstract

AIM: The present study tests the consistency of echocardiographic criteria for the grading of aortic valve stenosis. METHODS AND RESULTS: Current guidelines/recommendations define severe stenosis as an aortic valve area (AVA) <1 cm2 (or <0.6 cm2 adjusted for body surface area), mean pressure gradient (DeltaPm) >40 mmHg, or peak flow velocity (Vmax) >4 m/s. We tested the consistency of the three criteria for the grading of aortic valve stenosis in 3483 echocardiography studies performed in 2427 patients with normal left ventricular (LV) systolic function and a calculated AVA of < or =2 cm2. We calculated curve fits for the relationship between AVA and DeltaPm using the Gorlin equation and between AVA and Vmax based on the continuity equation for our study population. An AVA of 1.0 cm2 correlated to a DeltaPm of 21 mmHg and a Vmax of 3.3 m/s. Conversely, a DeltaPm of 40 mmHg corresponds to an AVA of 0.75 cm2 and a Vmax of 4.0 m/s to an AVA of 0.82 cm2. Consequently, severe stenosis was diagnosed in 69% of patients based on AVA, 45% on Vmax, and 40% on DeltaPm. Stroke volume was lower in inconsistently graded patients (65 +/- 11 mL vs. consistently graded: 70 +/- 14 mL, P < 0.001). CONCLUSION: The criteria for the grading of aortic stenosis are inconsistent in patients with normal systolic LV function. On the basis of AVA, a higher proportion of patients is classified as having severe aortic valve stenosis compared with mean pressure gradient and peak flow velocity. Discrepant grading in these patients may be partly due to reduced stroke volume.

Author information

Author/s: Minners, Jan (J); Allgeier, Martin (M); Gohlke-Baerwolf, Christa (C); Kienzle, Rolf-Peter (RP); Neumann, Franz-Josef (FJ); Jander, Nikolaus (N);

Affiliation: Department of Cardiology, Herz-Zentrum Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany. jan.minners(-atsign-)herzzentrum.de

Journal and publication information

Publication Type: Journal Article

Journal: European heart journal (Eur Heart J), published in England. (Language: eng)

Reference: 2008-Apr; vol 29 (issue 8) : pp 1043-8

Dates: Created 2008/04/15; Completed 2008/08/28;

PMID: 18156619, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Eur Heart J. 2008 Apr;29(8):966-8. (PMID: 18343797)

External Links for this article
(including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.