RT Journal Article
SR Electronic
T1 Valve area and the risk of overestimating aortic stenosis
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 911
OP 919
DO 10.1136/heartjnl-2018-314482
VO 105
IS 12
A1 Ana González-Mansilla
A1 Pablo Martinez-Legazpi
A1 Andrea Prieto
A1 Elena Gomá
A1 Pilar Haurigot
A1 Candelas Pérez del Villar
A1 Victor Cuadrado
A1 Antonia Delgado-Montero
A1 Raquel Prieto
A1 Teresa Mombiela
A1 Esther Pérez-David
A1 Elena Rodríguez González
A1 Yolanda Benito
A1 Raquel Yotti
A1 Manuel Pérez-Vallina
A1 Francisco Fernández-Avilés
A1 Javier Bermejo
YR 2019
UL http://heart.bmj.com/content/105/12/911.abstract
AB Objective To obtain reference values of aortic valve area (AVA) in a large population and to infer the risk of overestimating aortic stenosis (AS) when focusing on flow-corrected indices of severity.Methods We prospectively measured indices of AS in all consecutive echocardiograms performed in a large referral cardiac imaging laboratory for 1 year. We specifically analysed the distribution of AVA, indexed AVA and velocity ratio (Vratio) in patients with and without AS, the latter defined as the coexistence of valvular outflow obstruction (Vmax ≥2.5 m/s) and morphological findings of valve degeneration.Results 16 156 echocardiograms were analysed, 14 669 of which did not show valvular obstruction (peak jet velocity <2.5 m/s). In the latter group, AVA was 2.6±0.7 cm2 in 8190 studies with normal valves and 2.3±0.7 cm2 in 6479 studies with aortic sclerosis (AScl). There was a relatively wide overlap between values of AVA, indexed AVA and velocity ratio between studies of patients with AScl and AS. Values of AVA ≤1.0 cm2 were found in 0.5% of studies with normal valves and 1.8% of studies with AScl. These proportions were 3.1% and 9.3% for AVA ≤1.5 cm2, respectively. Vratio ≤0.25 were found in 0.1% of patients without obstruction. Risk factors for a small AVA in patients without obstruction were AScl, female sex, small body surface area, low ejection fraction and mitral regurgitation.Conclusions Normal values of continuity-equation derived AVA are smaller than previously considered. AVA values below cutoffs of moderate or severe AS can be found in patients without the disease. Flow-corrected indices may overestimate AS in patients with low gradients, particularly in the presence of well-identified risk factors.