title: Inconsistencies of echocardiographic criteria for the grading of aortic valve stenosis.
abstract: OBJECTIVE
  The present study tests the consistency of echocardiographic criteria for the grading of aortic valve stenosis.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Herz-Zentrum Bad Krozingen, Suedring 15, 79189 Bad Krozingen, Germany. jan.minners@herzzentrum.de
authors.forename: Jan
authors.initials: J
authors.lastname: Minners
authors.forename: Martin
authors.initials: M
authors.lastname: Allgeier
authors.forename: Christa
authors.initials: C
authors.lastname: Gohlke-Baerwolf
authors.forename: Rolf-Peter
authors.initials: RP
authors.lastname: Kienzle
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Jander
mesh_terms: D000208:Acute Disease; D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure; D004452:Echocardiography / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*