Quantitative Doppler echocardiography is the gold standard method for assessing the degree of aortic stenosis (AS), which is classified as mild, moderate or severe. This technique was validated in the latter part of the 20th century against the gold standard of that time, cardiac catheterisation derived valve area using the Gorlin hydraulic principle.1 In echocardiography, the Doppler parameters used to assess stenosis severity include the peak transvalvular velocity (AV Vmax), mean pressure gradient and the effective orifice area (EOA), determined using the continuity equation. Assessing AS is straight forward when all parameters indicate the same severity of stenosis—for example, if the AV Vmax, mean gradient and EOA all indicate mild AS—but becomes more challenging when the parameters do not all indicate the same severity—for example, the AV Vmax and mean gradient indicate moderate AS, yet the EOA suggests severe AS. In the former example, the parameters are concordant whereas in the latter they are discordant . Over a decade ago, Minners et al analysed 3483 echocardiograms to assess the frequency of these inconsistencies and they found that almost a third of patients with severe AS based on EOA (<1.0 cm2) had a mean gradient in the moderate AS category (ie, <40 mm Hg).2 Furthermore, the authors plotted curves using the original Gorlin formula to assess the relationships between EOA, mean gradient and AV Vmax. They found that an AVA of 1.0 cm2 correlated to a mean gradient of 21 mm Hg and an AV Vmax of 3.3 m/s. Conversely, a mean gradient of 40 mm Hg corresponded to an EOA of 0.75 cm2 (not 1.0 cm2) and an AV Vmax of 4.0 m/s corresponded to an EOA of 0.82 cm2. Thus, in their cohort, severe AS was diagnosed in 69% of patients based on EOA but …

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不一致的中度主动脉瓣狭窄：临床上重要吗？

定量多普勒超声心动图是评估主动脉瓣狭窄 (AS) 程度的金标准方法，分为轻度、中度或重度。这项技术在 20 世纪后期得到了验证，对照当时的金标准，心导管插入术使用 Gorlin 液压原理获得瓣膜面积。1 在超声心动图中，用于评估狭窄严重程度的多普勒参数包括峰值跨瓣速度 (AV Vmax)、平均压力梯度和有效孔口面积 (EOA)，使用连续性方程确定。当所有参数表明狭窄的严重程度相同时，评估 AS 是直接的——例如，如果 AV Vmax、平均梯度和 EOA 都表明轻度 AS——但当参数并不都表明相同的严重程度时变得更具挑战性——例如，AV Vmax 和平均梯度表明中度 AS，而 EOA 表明严重 AS。在前一个例子中，参数是一致的，而在后一个例子中它们是不一致的。十多年前，Minners 等人分析了 3483 次超声心动图以评估这些不一致的频率，他们发现几乎三分之一的基于 EOA（<1.0 cm2）的重度 AS 患者的平均梯度为中度 AS 类别（即， <40 mm Hg).2 此外，作者使用原始 Gorlin 公式绘制曲线以评估 EOA、平均梯度和 AV Vmax 之间的关系。他们发现 1.0 cm2 的 AVA 与 21 mm Hg 的平均梯度和 3.3 m/s 的 AV Vmax 相关。相反，40 mm Hg 的平均梯度对应于 0.75 cm2（不是 1.0 cm2）的 EOA，4.0 m/s 的 AV Vmax 对应于 0.82 cm2 的 EOA。因此，