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Direct comparison of severity grading assessed by two-dimensional, three-dimensional, and doppler echocardiography for predicting prognosis in asymptomatic aortic stenosis

Citation

Nabeshima, Y and Nagata, Y and Negishi, K and Seo, Y and Ishizu, T and Sato, K and Aonuma, K and Koto, D and Izumo, M and Akashi, YJ and Yamashita, E and Oshima, S and Otsuji, Y and Takeuchi, M, Direct comparison of severity grading assessed by two-dimensional, three-dimensional, and doppler echocardiography for predicting prognosis in asymptomatic aortic stenosis, Journal of the American Society of Echocardiography, 31, (10) pp. 1080-1090. ISSN 0894-7317 (2018) [Refereed Article]

Copyright Statement

Copyright 2018 by the American Society of Echocardiography.

DOI: doi:10.1016/j.echo.2018.05.006

Abstract

Background: Reliable assessment of aortic stenosis (AS) severity relies on stroke volume (SV) determination using Doppler echocardiography, but it can also be estimated with two-dimensional/three dimensional echocardiography (2DE/3DE). The aim of this study was to compare SV measurements and AS subgroup classifications among the three modalities and determine their prognostic strength in asymptomatic AS.

Methods: We prospectively enrolled 359 patients with asymptomatic AS. SV was determined using three methods, and the patients were divided into four AS subgroups according to indexed aortic valve area (iAVA) and SV index (SVI) determined by each method and mean pressure gradient. The primary end point was major adverse cardiovascular events (MACEs), which included cardiac death, ventricular fibrillation, heart failure, and aortic valve replacement. We also assessed the presence or absence of upper septal hypertrophy.

Results: Doppler-derived SVI was significantly larger than that derived from 2DE/3DE with modest correlations (r = 0.33 and 0.47). Thus, group classification varied substantially by modality. During the median follow-up period of 17 months, 112 patients developed a major adverse cardiovascular event. Although iAVA assessed by Doppler echocardiography had a significantly better net reclassification improvement compared with iAVA by 2DE or 3DE, prognostic values were nearly identical among the three methods. Ventricular septal geometry affected the accuracy of risk stratification.

Conclusions: AS severity grading varied considerably according to the methods applied for calculating SV. Thus, SV measurements are not interchangeable, even though their prognostic power is similar. Hence, examiners should select one of the three methods to assess AS severity and should use the same method in longitudinal examinations.

Item Details

Item Type:Refereed Article
Keywords:aortic stenosis, asymptomatic, comparison, echocardiography, prognosis
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
UTAS Author:Negishi, K (Dr Kazuaki Negishi)
ID Code:129219
Year Published:2018
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-11-15
Last Modified:2018-12-17
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