Although Doppler evaluation using a multiplanar method is recommended to assess the severity of aortic stenosis (AS) with transthoracic echocardiography, evidence on the diagnostic significance of a non-apical method is limited. This study aimed to compare the use of the apical with the use of the right parasternal view (RPV) method to evaluate AS severity and to examine the diagnostic significance of performing the RPV method in addition to the apical method during the evaluation.

Methods

This retrospective observational study included 276 consecutive patients (mean age: 79 ± 10 years; women, 56%) with severe AS (aortic valve area [AVA] ≤1.0cm²). The severity of AS according to the apical method and that according to the RPV for all subjects were compared, and the significance of performing the RPV method in addition to the apical method was examined. Furthermore, we compared the concordance group, in which the apical and RPV methods indicated matching in severity, and the discordant group, in which the apical and RPV methods did not indicate matching severity.

Results

Peak velocity (V_max), mean pressure gradient (MG) were significantly higher and the AVA, AVAi, and Doppler velocity index (DVI) were significantly smaller when the RPV was added to the apical view. Performing the RPV method in addition to the apical method significantly decreased the number of low PG AS cases (MG < 40 mmHg) from 69.9% to 65.0% and it increased the number of very severe AS cases (V_max ≥ 5 m/s) from 8.7% to 14.5%. Deviation of Doppler angle was significantly greater in the discordant group compared to the concordant group (22.5 ± .6 vs. 31.8 ± 1.7, p < .001).

Conclusions

By performing the RPV method in addition to the apical method to determine AS severity, the diagnosis of AS to be resolved in approximately 10% of cases. These results suggest that AS severity may be underestimated by using the apical method alone.

CONFLICTS OF INTEREST

Masaki Izumo is a member of Echocardiography's Editorial Executive Board and the authors have no conflicts of interest to declare.

REFERENCES

1Nkomo VT, Julius MG, Thomas NS, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368(9540): 1005-1011.
10.1016/S0140-6736(06)69208-8
PubMed Web of Science® Google Scholar
2Onishi H, Izumo M, Mitomo S, et al. Resting echocardiographic predictors for true-severe aortic stenosis in patients with low-gradient severe aortic stenosis: a dobutamine stress echocardiography study. Echocardiography. 2021; 38(10): 1731-1740.
10.1111/echo.15201
PubMed Web of Science® Google Scholar
3Izumi C, Eishi K, Ashihara K, et al. Guideline on the management of valvular heart disease. Circulation J. 2020; 84(11): 2037-2119.
10.1253/circj.CJ-20-0135
PubMed Web of Science® Google Scholar
4Baumgartner H, Judy H, Javier B, et al. Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the european association of cardiovascular imaging and the American society of echocardiography. J Am Soc Echocardiogr. 2017; 30(4): 372-392.
10.1016/j.echo.2017.02.009
PubMed Web of Science® Google Scholar
5Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022; 43(7): 561-632.
10.1093/eurheartj/ehab395
PubMed Web of Science® Google Scholar
6Benfari G, Mantovani F, Romero-Brufau S, et al. The right parasternal window: when Doppler-beam alignment may be life-saving in patients with aortic valve stenosis. J Cardiovasc Med. 2020; 21(10): 831-834.
10.2459/JCM.0000000000000971
Google Scholar
7Cho EJ, Kim SM, Park SJ, et al. Identification of factors that predict whether the right parasternal view is required for accurate evaluation of aortic stenosis severity. Echocardiography. 2016; 33(6): 830-837.
10.1111/echo.13181
PubMed Web of Science® Google Scholar
8Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American society of echocardiography. J Am Soc Echocardiogr. 2019; 32(1): 1-64.
10.1016/j.echo.2018.06.004
PubMed Web of Science® Google Scholar
9Abe Y. Screening for aortic stenosis using physical examination and echocardiography. J Echocardiogr. 2021; 19(2): 80-85.
10.1007/s12574-020-00511-8
PubMed Web of Science® Google Scholar
10Michalski B, Dweck MR, Marsan NA, et al. The evaluation of aortic stenosis, how the new guidelines are implemented across Europe: a survey by EACVI. Eur Heart J Cardiovasc Imaging. 2020; 21(4): 357-362.
10.1093/ehjci/jeaa009
PubMed Web of Science® Google Scholar
11Hatle L, Angelsen BA, Tromsdal A. Non-invasive assessment of aortic stenosis by Doppler ultrasound. Br Heart J. 1980; 43(2): 284-292.
10.1136/hrt.43.3.284
CAS PubMed Google Scholar
12Deeprasertkul P, Ahmad M. Evolving new concepts in the assessment of aortic stenosis. Echocardiography. 2017; 34(5): 731-745.
10.1111/echo.13501
PubMed Web of Science® Google Scholar
13Williams GA, Arthur JL, Jeanne GN, et al. Value of multiple echocardiographic views in the evaluation of aortic stenosis in adults by continuous-wave Doppler. Am J Cardiol. 1985; 55(4): 445-449.
10.1016/0002-9149(85)90391-1
CAS PubMed Web of Science® Google Scholar
14Stamm RB, Martin RP. Quantification of pressure gradients across stenotic valves by Doppler ultrasound. J Am Coll Cardiol. 1983; 2(4): 707-718.
10.1016/S0735-1097(83)80311-8
CAS PubMed Web of Science® Google Scholar
15Benfari G, Gori AM, Rossi A, et al. Feasibility and relevance of right parasternal view for assessing severity and rate of progression of aortic valve stenosis in primary care. Int J Cardiol. 2017; 240: 446-451.
10.1016/j.ijcard.2017.04.091
PubMed Web of Science® Google Scholar
16Benfari G, Nistri S, Cerrito LF, et al. Usefulness of the right parasternal echocardiographic view to improve the hemodynamic assessment after valve replacement for aortic stenosis. Am J Cardiol. 2021; 142: 103-108.
10.1016/j.amjcard.2020.11.028
PubMed Web of Science® Google Scholar
17Thaden JJ, Nkomo VT, Lee KJ, et al. Doppler imaging in aortic stenosis: the importance of the nonapical imaging windows to determine severity in a contemporary cohort. J Am Soc Echocardiogr. 2015; 28(7): 780-785.
10.1016/j.echo.2015.02.016
PubMed Web of Science® Google Scholar

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Volume39, Issue10

October 2022

Pages 1338-1343

Additive value of the right parasternal view for the assessment of aortic stenosis

Abstract

Background

Methods

Results

Conclusions

CONFLICTS OF INTEREST

REFERENCES

Citing Literature

References

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Additive value of the right parasternal view for the assessment of aortic stenosis

Abstract

Background

Methods

Results

Conclusions

CONFLICTS OF INTEREST

REFERENCES

Citing Literature

References

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