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Take home messages with cases from focused update on echocardiographic assessment of aortic stenosis
  1. Judy Hung1,
  2. Sheila Liu Klassen1,
  3. Javier Bermejo2,
  4. John Boyd Chambers3
  1. 1 Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2 Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV, Madrid, Spain
  3. 3 Department of Cardiology, Guy’s and St. Thomas’ Hospitals, London, UK
  1. Correspondence to Dr Judy Hung, Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; jhung{at}


Echocardiography plays an important role in the assessment of valvular aortic stenosis. Updated recommendations focusing on a stepwise approach to evaluating aortic stenosis have recently been published by the European Association of Cardiovascular Imaging and the American Society of Echocardiography. This review uses illustrative cases to demonstrate technical aspects of aortic stenosis assessment and use of the new proposed classification scheme for aortic stenosis. Key points from the updated recommendations reviewed in this paper are: (1) technical considerations and sources of error in measurement of peak velocity, mean aortic valve gradient and aortic valve area by continuity equation. (2) Application of flow status using indexed left ventricular stroke volume to distinguish patients with low gradients and a low calculated aortic valve area. (3) Use of low-dose dobutamine stress echocardiography in patients with low ejection fraction. (4) Application of the new classification scheme and review of algorithm use for echocardiographic evaluation of severe aortic stenosis. Improved understanding of how to handle unmatched variables and adopting an integrated approach to determine severity is central to guiding the clinician’s management of aortic stenosis.

  • echocardiography
  • aortic stenosis

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  • Contributors JH and SLK drafted the manuscript and compiled the illustrative cases in this review. JB and JBC suggested key edits and changes to the manuscript. All authors completed final edits and agreed on final version for submission.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.