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Comparison of invasive and noninvasive assessment of aortic stenosis severity in the elderly.

Abstract

BACKGROUND
Aortic valve area (AVA) in aortic stenosis (AS) can be assessed noninvasively or invasively, typically with similar results. These techniques have not been validated in elderly patients, where common assumptions make them most prone to error. Accurate assessment of AVA is crucial to determine which patients are appropriate candidates for aortic valve replacement.
METHODS AND RESULTS
Fifty elderly patients (mean 86 years, 46% female) referred for cardiac catheterization to evaluate AS also underwent transthoracic echocardiography within 24 hours. To minimize assumptions all patients had 3-dimensional echocardiography (Echo-3D), and at catheterization using directly measured oxygen consumption (Cath-mVo(2)) and thermodilution cardiac output (Cath-TD). Correlation between Cath-mVo(2) and Echo-3D AVA was poor (r=0.41). Cath-TD AVA had a moderate correlation with Echo-3D AVA (r=0.59). Cath-mVo(2) (AVA=0.69 cm(2)) and Cath-TD (AVA=0.66 cm(2)) underestimated AVA compared with Echo-3D (AVA=0.76 cm(2;) P=0.08 for comparison with Cath-mVo(2); P=0.001 for Cath-TD). Compared with Echo-3D, the sensitivity and specificity for determining critical disease (AVA <0.8 cm(2)) were 81% and 42% for Cath-mVo(2), and 97% and 53% for Cath-TD. The only independent predictor of the difference between noninvasive and invasive AVA was stroke volume index (P<0.01). Resistance, a less flow-dependent measure, showed a stronger correlation between Echo-3D and Cath-mVo(2) (r=0.69), and Echo-3D and Cath-TD (r=0.77).
CONCLUSIONS
Standard techniques of AVA assessment for AS show poor correlation in elderly patients, with frequent misclassification of critical AS. Less flow-dependent measures, such as resistance, should be considered to ensure that only appropriate patients are treated with aortic valve replacement.

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  • Publisher Full Text
  • Authors

    Gertz ZM, Raina A, O'Donnell W, McCauley BD, Shellenberger C, Kolansky DM, Wilensky RL, Forfia PR, Herrmann HC

    Institution

    Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.

    Source

    Circulation. Cardiovascular interventions 5:3 2012 Jun pg 406-14

    MeSH

    Age Factors
    Aged, 80 and over
    Aortic Valve
    Aortic Valve Stenosis
    Echocardiography, Doppler
    Echocardiography, Three-Dimensional
    Female
    Heart Catheterization
    Hemodynamics
    Humans
    Linear Models
    Male
    Multivariate Analysis
    Oxygen Consumption
    Philadelphia
    Predictive Value of Tests
    Prognosis
    Sensitivity and Specificity
    Severity of Illness Index
    Thermodilution

    Pub Type(s)

    Comparative Study
    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    22647520