Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis
Abstract
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 (DeltaPm) >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 < or =2 cm2. We calculated curve fits for the relationship between AVA and DeltaPm 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 DeltaPm of 21 mmHg and a Vmax of 3.3 m/s. Conversely, a DeltaPm 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 DeltaPm. 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.
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One third of patients with a severe aortic stenosis on the basis of aortic valve area (<1.0 cm2) present with a low gradient (<40 mm Hg) suggestive of nonsevere aortic stenosis.
“However, one third of patients with a “severe AS” on the basis of the AVA (<1.0 cm2) present with a low gradient (<40 mm Hg) suggestive of nonsevere AS. 22 , 23 , 24”
From Grading of Aortic Valve Calcification Severity and Risk Stratification in Aortic Stenosis (2024) · cites this paper as [23]
Figure 1 (Discussion; page unavailable) reports the claimed mismatch between severe stenosis by aortic valve area and nonsevere stenosis by mean pressure gradient. But its 30% is a share of all echocardiographic studies, not of those classified as severe by valve area. The Abstract reports that 69% were classified as severe by valve area, making the mismatched group about 43% of that subgroup, rather than one third. (LLM, conf=0.88)
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References 22 · Cited by 387
- Authors
- Minners, J., Allgeier, M., Gohlke-Baerwolf, C., Kienzle, R.-P., Neumann, F.-J., & Jander, N.
- Affiliations
- Universitäts-Herzzentrum Freiburg-Bad Krozingen (DE)
- Corresponding author
- Minners, Jan
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2007-12-22
- Volume
- 29
- Issue
- 8
- Pages
- 1043-1048
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- OpenAlex
- W2058377958
- Cited by
- 387
- References
- 22
- Citations by year
- 2026: 12 · 2025: 10 · 2024: 25 · 2023: 20 · 2022: 17 · 2021: 29 · 2020: 27 · 2019: 27 · 2018: 21 · 2017: 29 · 2016: 27 · 2015: 30 · 2014: 25 · 2013: 28 · 2012: 26
- FWCI
- 5.15
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Heart Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- aortic stenosis, severity classification, echocardiographic criteria, aortic valve area, mean pressure gradient, peak flow velocity, continuity equation, stroke volume, normal left ventricular systolic function, diagnostic discordance
- MeSH terms
- Acute Disease, Aged, Aortic Valve Stenosis, Blood Flow Velocity, Blood Pressure, Echocardiography, Female, Humans, Male, Stroke Volume, Systole, Ventricular Function, Left, Practice Guidelines as Topic
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