Importance of Discordant Echocardiographic Parameters of Lesion Severity in Patients with Symptomatic Aortic Stenosis

Mean Pressure gradient (PG) of ­>40mmHg and valve area of >40mmHg) and discordant (AVA<1.0cm2; PG<40mmHg) echocardiographic findings on stenosis severity defined by invasive hemodynamic evaluation.

The study population comprised 55 symptomatic patients with AS and an ejection fraction of >50% who underwent both complete echocardiographic evaluation with determination of mean PG, AVA and Dimensional Index (DI) and cardiac catheterization. Severe AS was defined by an AVA

Mean patient age was 81±6 years old, 27 were male. Only 12.5% (4/32) patients with concordant echocardiographic findings, but 21.7% (5/23) of those with discordant findings, had an invasively determined AVA>1.0 cm2 (p<0.03). Patients with concordant findings had a significantly lower AVA (0.69+0.15cm2) than patients with discordant findings (0.86+0.2cm2; p<0.01) and a significantly lower DI (0.21.0+0.05 versus 0.26.2+0.06; p<0.02). However, neither adding the criterion of DI, nor replacing the cut-off value for echocardiographically determined AVA to 0.8cm2 reduced misclassifications significantly.

Conclusion: In a cohort of symptomatic patients with AS, discordant echocardiographic severity findings carry an almost 74% higher rate of misclassification than concordant findings when compared with invasive measurements. Discordant echocardiographic findings define a potentially heterogeneous group of patients that require further evaluation.