scholarly journals 1044 Simple echocardiographic scoring in screening for aortic stenosis by emergency physicians in the emergency department

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Furukawa ◽  
Y Abe ◽  
T Miyaji ◽  
M Hatakenaka ◽  
M Naito ◽  
...  
Keyword(s):  
Emergency Department ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Predictive Value ◽  
Continuity Equation ◽  
Aortic Valve Area ◽  
Short Axis ◽  
Short Axis View ◽  
Emergency Physicians ◽  
Axis View

Abstract Background; Aortic stenosis (AS) is one of the important critical diseases and may influence hemodynamics in cardiovascular or non-cardiovascular emergency, however, there is no established methodology to diagnose AS in a focused cardiac ultrasound (FOCUS). We have previously reported that our developed visual AS score was a simple index for AS screening using rapid echocardiography and it could successfully diagnose clinically significant AS. The purpose of the present study was to evaluate the diagnostic accuracy of visual AS score assessed by emergency physicians in the emergency department. Methods; Visual AS score was calculated as the sum of the scores of each three aortic cusp’s opening in a short-axis view scored as follows: 0 = not restricted, 1 = restricted, or 2 = severely restricted; and classified in 0 – 6 as we previously reported. Emergency physicians who did not specialize in cardiology or ultrasonography underwent basic 30 minutes training to visualize aortic valve in a short-axis view and to assess visual AS score beforehand. They performed echocardiography and evaluated visual AS score in emergency outpatients with suspected cardiovascular diseases such as chest symptom, consciousness disorder, abnormal vital signs, heart murmur or abnormal electrocardiogram in the emergency department. Then, another assessment of visual AS score and complete echocardiography including quantitative assessment of AS was performed by expert sonographers. Aortic valve area index (AVAI) was calculated using continuity equation and body surface area, and an AVAI > 0.85 cm/m2, 0.6 - 0.85 cm/m2, and < 0.6 cm/m2 were defined as none or mild, moderate and severe AS, respectively. Results: Sixty patients underwent evaluations of visual AS score by emergency physicians. Visual AS score could not be assessed in 5 patients and continuity equation could not be evaluated in 2 patients, both due to poor echocardiographic imaging quality. Visual AS scores assessed by emergency physicians and expert sonographers showed strong positive correlation (R = 0.94, P < 0.0001). Fourteen patients (26 %) including 6 with shock or hypotension, 3 with congestive heart failure, 2 with syncope, 1 with acute myocardial infarction, 1 with suspected cardiac tamponade and 1 with abnormal electrocardiogram had moderate or more degree of AS in complete echocardiography performed by expert sonographers. Visual AS score 3 or more assessed by emergency physicians had 86 %, 100 %, 100 % and 95 % of a diagnostic sensitivity, specificity, positive predictive value and negative predictive value, respectively. Conclusion: Visual AS score in FOCUS is useful to screen for AS for emergency physicians who do not specialize in cardiology.

Measurement of Aortic Valve Area by Simplified Continuity Equation in Aortic Stenosis With Atrial Fibrillation

1995 ◽  
Vol 25 (3) ◽  
pp. 635
Author(s):  
Hyeon-Cheol Gwon ◽  
Ju-Hee Zo ◽  
Hyo-Soo Kim ◽  
Dae-Won Sohn ◽  
Byung-Hee Oh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Continuity Equation ◽  
Aortic Valve Area ◽  
Valve Area

scholarly journals Impact of left ventricular outflow tract flow acceleration on aortic valve area calculation in patients with aortic stenosis

2019 ◽  
Vol 6 (4) ◽  
pp. 97-103 ◽  
Author(s):  
Andaleeb A Ahmed ◽  
Robina Matyal ◽  
Feroze Mahmood ◽  
Ruby Feng ◽  
Graham B Berry ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Continuity Equation ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Area Measurement ◽  
Aortic Valve Area ◽  
Flow Acceleration ◽  
The Impact ◽  
Valve Area

Objective Due to its circular shape, the area of the proximal left ventricular tract (PLVOT) adjacent to aortic valve can be derived from a single linear diameter. This is also the location of flow acceleration (FA) during systole, and pulse wave Doppler (PWD) sample volume in the PLVOT can lead to overestimation of velocity (V1) and the aortic valve area (AVA). Therefore, it is recommended to derive V1 from a region of laminar flow in the elliptical shaped distal LVOT (away from the annulus). Besides being inconsistent with the assumptions of continuity equation (CE), spatial difference in the location of flow and area measurement can result in inaccurate AVA calculation. We evaluated the impact of FA in the PLVOT on the accuracy of AVA by continuity equation (CE) in patients with aortic stenosis (AS). Methods CE-based AVA calculations were performed in patients with AS once with PWD-derived velocity time integral (VTI) in the distal LVOT (VTILVOT) and then in the PLVOT to obtain a FA velocity profile (FA-VTILVOT) for each patient. A paired sample t-test (P < 0.05) was conducted to compare the impact of FA-VTILVOT and VTILVOT on the calculation of AVA. Result There were 46 patients in the study. There was a 30.3% increase in the peak FA-VTILVOT as compared to the peak VTILVOT and AVA obtained by FA-VTILVOT was 29.1% higher than obtained by VTILVOT. Conclusion Accuracy of AVA can be significantly impacted by FA in the PLVOT. LVOT area should be measured with 3D imaging in the distal LVOT.

Aortic valve regurgitation

2021 ◽  
pp. 181-190
Author(s):  
Julien Magne ◽  
Patrizio Lancellotti
Keyword(s):  
Aortic Valve ◽  
Transoesophageal Echocardiography ◽  
Correct Identification ◽  
Short Axis ◽  
Short Axis View ◽  
Valve Regurgitation ◽  
Chamber View ◽  
Imaging Tool ◽  
Line Imaging ◽  
Axis View

Transthoracic echocardiography (TTE) is the first-line imaging tool to assess aortic valve (AV), aorta, and subsequent aortic regurgitation (AR). The parasternal long-axis view is classically used to measure the left outflow tract, the aortic annulus, and the aortic sinuses. Leaflet thickening and morphology can be visualized from this window as well as from the parasternal short-axis view and the apical five-chamber view. Nevertheless, 2D TTE may be limited and not enabling correct identification of the anatomy and causes of AR. In this situation, 3D echocardiography and cardiac magnetic resonance (CMR) could provide better delineation of the AV morphology. In some cases, transoesophageal echocardiography (TOE) could be required, more particularly for assessing the aortic root dimensions.

Abstract 18065: Combining Echo Doppler and CT Derived LVOT Measurements Improve Accuracy of Continuity Equation Based Aortic Valve Area Determination

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Sami Alnasser ◽  
Asim Cheema ◽  
Vamshi Kotha ◽  
Djeven Deva ◽  
Jeremy Edwards ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Correlation Coefficient ◽  
Continuity Equation ◽  
Severe Aortic Stenosis ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Left Ventricular Outflow ◽  
Valve Area

Background: Left ventricular outflow tract (LVOT) measurement by Echo falsely assumes circular LVOT with implications for aortic valve area (AVA) determined using continuity equation. In this study, we investigated the utility of combining Echo Doppler and computed tomography (CT) based LVOT area for precise AVA assessment. Methods: AVA-echo was calculated using continuity equation and standard echocardiography techniques. CT-LVOT area was measured by 3 independent readers. Blinded measurements were obtained in candidates for percutaneous aortic valve replacement. AVA-CT was calculated using CT-LVOT area and echo Doppler measurements. The inter-observer variability for CT-LVOT area and correlation between AVA-echo and AVA-CT was analyzed using intra-class (ICC) and Spearman correlation coefficient. Results: Complete data for 66 patients was analyzed. The ICC for CT derived LVOT measurement by three observers was 0.96 demonstrating excellent reliability. The LVOT area by echo was significantly smaller than that obtained by CT (3.43±0.8 vs. 4.45±1.2 cm2, p<0.0001) and showing moderate correlation (r=0.66, p=0.006). Similarly, the AVA-echo was significantly lower compared to AVA-CT (0.76±0.46 vs. 0.97±0.53 cm2, p<0.0001). The correlation coefficient for AVA-echo and AVA-CT was 0.7 (p < 0.0001), 0.4 (p=0.06) and 0.9 (p<0.0001) for AVA-echo of 0.8 cm2 respectively. The regression analysis showed that AVA-CT could be predicted by applying a correction factor to the AVA-echo as AVA-CT = AVA-echo x 1.1+0.14. Conclusion: CT provides accurate and reliable LVOT assessment. Combining CT-LVOT and echo Doppler measurements result in a larger AVA compared to AVA-echo representing a true anatomic measurement. These findings have important implications for grading of aortic stenosis and management of patients with moderate to severe aortic stenosis.

scholarly journals Pace of progression of aortic stenosis severity in patients with tricuspid and bicuspid valve

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P.H Hamala ◽  
J.D.K Kasprzak ◽  
K.W.D Wierzbowska-Drabik
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Continuity Equation ◽  
Peak Pressure ◽  
Progression Rate ◽  
Funding Source ◽  
Aortic Valve Area ◽  
Time Points ◽  
Stenosis Severity ◽  
Valve Area

Abstract Background Knowledge about determinants and pace of aortic stenosis (AS) progression may improve classification to aortic valve replacement. We quantified and compared pace of AS progression in patients with tricuspid and bicuspid aortic valve (TAV and BAV) examined by transthoracic echocardiography (TTE) in years 2004–2019. Methods We analysed retrospectively 322 TTE performed in two time points (median time between examinations 31±31 months) in 161 AS patients (mean age 69±11 years, 101 male, 40 BAV), evaluating the changes of parameters reflecting AS severity: peak pressure gradient (PG), aortic valve area by planimetry (AVApl) and continuity equation (AVAce). Then we compared pace of AS progression (defined as change of parameters per year) between patients with BAV and TAV and searched for correlates of AS progression. Results Although patients with BAV were younger, cardiovascular risk factors profile and baseline AS advancement were similar in both groups, see Table. Severe AS was present in 20% in BAV and 21% in TAV, p=ns. Patients with BAV showed circa 3 times more rapid AS progression expressed as the increase of PG per year (18.5±41.3 mmHg vs 4.1±34.4 mmHg in TAV, p=0.03) and yearly AVAce decrease (−0.23±0.27 vs −0.03±0.32, p=0.028). Smaller AVA value at baseline predicted faster pace of AS progression (with correlation coefficient r=−0.34, p=0.002 for AVApl). Conclusion Progression rate of AS depends on valve morphology being more rapid in BAV with similar to TAV baseline AS severity. In the whole group pace of progression correlated negatively with baseline AVA. Funding Acknowledgement Type of funding source: None

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