Value and limitations of cross-sectional echocardiography of the aortic valve in the diagnosis and quantification of valvular aortic stenosis

A. N. DeMaria, William J Bommer, J. Joye, G. Lee, J. Bouteller, D. T. Mason

Research output: Contribution to journalArticle

79 Scopus citations

Abstract

Few data are available regarding cross-sectional echocardiography (2-D) in the diagnosis and quantification of valvular aortic stenosis. Therefore, we compared echographic measurements obtained by 2-D echo with aortic gradient and aortic valve area and index calculated by the Gorlin formula in 20 normal subjects and 85 patients with clinical evidence of aortic stenosis. Technically adequate echograms were obtained in 72 patients (85%). Forty-six patients with satisfactory echograms were classified as having critical aortic stenosis, while 26 were designated as having noncritical obstruction. Aortic leaflet separation (SEP) was measured as the maximal intercusp distance visualized in either long, apical or short axis of the 2-D echo. SEP was less in critical aortic stenosis patients than in normal subjects and those with noncritical aortic stenosis (4.6±0.4, 19.4±0.5, and 10.0±0.8 mm, respectively [mean ± SEM] [both p<0.001]) and was greater than 15 mm in all normal subjects and 11 mm or less in all patients in the critical group. SEP correlated poorly with peak systolic gradient and calculated aortic valve area and index in aortic stenosis patients. Forty-two of 46 patients in the critical group had SEP of 8 mm or less, yielding a sensitivity of 91%. However, only 17 of 26 patients with noncritical aortic stenosis had a SEP of greater than 8 mm, for a specificity of 65%. Therefore, the predictive value of SEP 8 mm or less on 2-D echo in the recognition of critical aortic stenosis was 82%. Two-dimensional echocardiography is a sensitive method to detect valvular aortic stenosis, and accurately separates patients with aortic stenosis from normal subjects. However, the specificity of 2-D echo in distinguishing critical from noncritical aortic stenosis is limited.

Original languageEnglish (US)
Pages (from-to)304-312
Number of pages9
JournalCirculation
Volume62
Issue number2
StatePublished - 1980

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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