Noninvasive evaluation of the severity of aortic stenosis in adults.
A noninvasive point score system for the evaluation of severity of aortic stenosis (AS) was employed in a prospective study of 153 patients (mean age 64.8 +/- 0.8 years) referred from invasive studies or for the evaluation of a systolic murmur. Seven variables were recorded and scored as follows: LVH by ECG (0-2); aortic valve calcium by chest x-ray film (0-2); loudness of A2 (0-2); Q-peak of murmur (0-3); T-time of carotid pulse (0-3); ejection time (0-3); and LVH by echo (0-1). Range of the total score was 0-16. All patients had the aortic valve area (AVA) determined by cardiac catheterization. Data analysis revealed that the relation between the total score and the AVA was curvilinear with a score greater than or equal to 5 correctly identifying 100/107 (93 percent) of patients with a valve area of less than or equal to 1.0 cm2. If the patients with an AVA of less than or equal to 1.0 cm2 were considered severe and patients with a total score less than 5 were considered mild-moderate, the sensitivity, specificity, and predictive accuracy for a score greater than or equal to 5 were 93 percent, 96 percent, and 98 percent, respectively. The relation between the score and aortic valve gradient (AVG) was linear with a score of greater than or equal to 5 correctly identifying 84/88 (95 percent) with an AVG greater than or equal to 40 mm Hg. If the patients with a pressure gradient over 40 mm Hg were considered severe, the sensitivity, specificity, and predictive accuracy for a score greater than or equal to 5 were 95 percent, 72 percent, and 82 percent, respectively. It is concluded that a point score system employing seven noninvasive variables is simple and accurate in identifying patients with severe AS and would be a valuable addition to a Doppler determined gradient.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D002118:Calcium / Q000032:analysis; D006328:Cardiac Catheterization; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D004452:Echocardiography; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010701:Phonocardiography; D011859:Radiography; D013318:Stroke Volume
D002118:Calcium