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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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Aortic stenosis quantification: is echocardiogram good enough for everyone?
Session:
Posters 2 - Écran 3 - Imagiologia Cardiovascular
Speaker:
João Baltazar Ferreira
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
João Baltazar Ferreira; Daniel Candeias Faria; Marco Beringuilho; d. Roque; H. Ferreira; João Bicho Augusto; C. Morais
Abstract
<p>Introduction</p> <p>Aortic stenosis treatment is currently mainly dictated by the symptomatic status of the patient and aortic stenosis severity. The most widely used method for stenosis severity quantification is transthoracic echocardiogram (TTE), based on transaortic gradients and assessment of aortic valve area (AVA) through continuity equation. Nevertheless, frequent discrepancies between aortic stenosis severity evaluated with transaortic gradients and AVA occur. We aimed to investigate whether echocardiographic image quality can play a role in those cases.</p> <p>Methods</p> <p>We retrospectively analysed 121 consecutive TTEs of patients with severe aortic stenosis, with AVA < 1.0cm2 as assessed by continuity equation. Patients with low-flow status were excluded (stroke volume (SV) < 35mL/min/m2). We therefore included 64 patients (females 42,2%, mean age 77,1 +- 9,4 years). Echocardiographic image quality was assessed by the operator as poor quality or good/average quality. We then compared the relationship of echocardiographic image quality with the parameters evaluated for aortic stenosis quantification.</p> <p>Results</p> <p>30 patients had transaortic Doppler parameters discordant from AVA. 18 patients had poor echocardiographic image quality. There was a significant association between discordant transaortic Doppler parameters (maximum velocity and mean gradient) from aortic stenosis severity and poor echocardiographic image quality (p = 0.001, OR = 7.5, CI 95% 2.1-26.6). In patients with poor echocardiographic image quality, there were significantly lower values of aortic maximum velocity (3.81 vs 4.25m/s, p = 0.01), aortic mean gradient (35.4 vs 46.8mmHg, p = 0.007) and aortic VTI (91 vs 106cm, p = 0.017) but not with left ventricle outflow tract (LVOT) VTI (21.4 vs 23.8cm, p = 0.08) and LVOT diameter (20.29 vs 20.32mm, p = 0.92).</p> <p>Conclusions</p> <p>In our study, given that the major differences were lower gradients and VTI of transaortic flow, it probably led to an overestimation of AVA in patients with poor image quality. However, these patients were already classified as having severe aortic stenosis by AVA and so, probably, image quality did not influence the treatment strategy. Meanwhile, this might be a problem in patients with aortic stenosis classified as moderate by AVA, especially because in those cases gradients might be concordant to AVA. So, when echocardiographic image quality is poor, it might be worthy to further assess aortic stenosis severity through other methods.</p>
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