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European Heart Journal Advance Access originally published online on December 22, 2007
European Heart Journal 2008 29(8):1043-1048; doi:10.1093/eurheartj/ehm543
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis

Jan Minners*, Martin Allgeier, Christa Gohlke-Baerwolf, Rolf-Peter Kienzle, Franz-Josef Neumann and Nikolaus Jander

Department of Cardiology, Herz-Zentrum Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany

Received 18 May 2007; revised 9 October 2007; accepted 29 October 2007; online publish-ahead-of-print 22 December 2007.

* Corresponding author. Tel: +49 7633 4020, Fax: +49 7633 402 5219. Email: jan.minners{at}herzzentrum.de

See page 966 for the editorial comment on this article (doi:10.1093/eurheartj/ehn080)

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 ({Delta}Pm) >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 ≤2 cm2. We calculated curve fits for the relationship between AVA and {Delta}Pm 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 {Delta}Pm of 21 mmHg and a Vmax of 3.3 m/s. Conversely, a {Delta}Pm 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 {Delta}Pm. 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.

Key Words: Aortic valve stenosis • Severity • Grading • Echocardiography


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