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.

中文翻译：

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二维，三维和多普勒超声心动图评估严重程度分级对无症状主动脉瓣狭窄预后的直接比较

背景

对主动脉瓣狭窄（AS）严重程度的可靠评估取决于使用多普勒超声心动图确定的卒中体积（SV），但也可以使用二维/三维超声心动图（2DE / 3DE）进行评估。这项研究的目的是比较三种方式之间的SV测量值和AS亚组分类，并确定它们在无症状AS中的预后强度。

方法

我们前瞻性招募了359例无症状AS患者。通过三种方法确定SV，根据每种方法确定的主动脉瓣面积指数（iAVA）和SV指数（SVI）以及平均压力梯度将患者分为四个AS子组。主要终点是主要的不良心血管事件（MACE），包括心源性死亡，心室纤颤，心力衰竭和主动脉瓣置换。我们还评估了上中隔肥大的存在与否。

结果

多普勒衍生的SVI明显大于具有适度相关性的2DE / 3DE衍生的SVI（r  = 0.33和0.47）。因此，群体分类因模态而有很大不同。在17个月的中位随访期内，有112名患者出现了严重的心血管不良事件。尽管通过多普勒超声心动图评估的iAVA与通过2DE或3DE进行的iAVA相比，净重分类改善显着更好，但三种方法的预后价值几乎相同。室间隔的几何形状影响风险分层的准确性。

结论

AS严重性等级根据用于计算SV的方法而有很大不同。因此，即使SV测量的预测能力相似，也无法互换。因此，检查人员应选择三种方法之一来评估AS严重程度，并且在纵向检查中应使用相同的方法。