title: Doppler-detected valve movement in aortic stenosis: a predictor of adverse outcome.
abstract: BACKGROUND
  The absence of auscultatory aortic valve closure sound is associated with severe aortic stenosis. The absence of Doppler-derived aortic opening (Aop ) or closing (Acl ) may be a sign of advanced severe aortic stenosis.
  
  
  OBJECTIVE
  Absent Doppler-detected Aop or Acl transient is indicative of very severe aortic stenosis and is associated with adverse outcome.
  
  
  METHODS
  A total of 118 consecutive patients with moderate (n = 63) or severe aortic stenosis (n = 55) were included. Aop and Acl signals were identified in a blinded fashion by continuous-wave Doppler. Patients with and without Aop and Acl were compared using χ(2) test for dichotomous variables and analysis of variance for continuous variables. The associations of Aop and Acl with aortic valve replacement were determined.
  
  
  RESULTS
  Aop or Acl were absent in 22 of 118 patients. The absence of Aop or Acl was associated with echocardiographic parameters of severe aortic stenosis. The absence of Aop or Acl was associated with incident aortic valve replacement (36.4% vs 7.3%, respectively, P < 0.001). Even in patients with aortic valve area <1 cm(2) , the absence of Aop or Acl was still associated with increased rate of aortic valve replacement (42.1% vs 13.9%, respectively, P = 0.019) and provided incremental predictive value over peak velocity.
  
  
  CONCLUSIONS
  In a typical population of patients with aortic stenosis, approximately 1 in 6 has no detectible aortic valve opening or closing Doppler signal. The absence of an Aop or Acl signal is a highly specific sign of severe aortic stenosis and is associated with incident aortic valve replacement.
authors.affiliation: Cardiology Department, Kaiser Permanente Medical Center, Redwood City, California; Cardiology Department, California Pacific Medical Center, San Francisco, California.
authors.forename: Xiushui
authors.initials: X
authors.lastname: Ren
authors.forename: Nader M
authors.initials: NM
authors.lastname: Banki
authors.forename: Richard E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Edward J
authors.initials: EJ
authors.lastname: McNulty
authors.forename: Sherry C
authors.initials: SC
authors.lastname: Williams
authors.forename: Michael
authors.initials: M
authors.lastname: Pencina
authors.forename: Nelson B
authors.initials: NB
authors.lastname: Schiller
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery; D001783:Blood Flow Velocity; D015150:Echocardiography, Doppler; D005260:Female; D006326:Heart Auscultation; D006333:Heart Failure / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index