Clinical Investigation
Valvular Heart Disease
A Novel and Simple Method Using Pocket-Sized Echocardiography to Screen for Aortic Stenosis

https://doi.org/10.1016/j.echo.2013.03.008Get rights and content

Background

Pocket-sized echocardiography may serve as an initial tool to screen for aortic stenosis (AS). The purpose of this study was to evaluate the usefulness of a novel and simple method using pocket-sized echocardiography to screen for AS.

Methods

Subjects (n = 130) with systolic ejection murmur or known AS were studied. After physical examination, each aortic cusp's opening was visually scored using pocket-sized echocardiography as follows: 0 = not restricted, 1 = restricted, or 2 = severely restricted. The sum of the scores was defined as the visual AS score. On the basis of high-end echocardiography, an aortic valve area index <0.60 cm2/m2 and an aortic valve area index of 0.60 to 0.85 cm2/m2 were considered to indicate severe and moderate AS, respectively.

Results

For diagnosing severe AS (n = 27), a visual AS score ≥4 had sensitivity of 85% and specificity of 89%. For diagnosing moderate to severe AS (n = 57), a visual AS score ≥3 had sensitivity of 84% and specificity of 90%. The areas under the receiver operating characteristic curves for diagnosing severe and moderate to severe AS with a visual AS score (0.946 and 0.936, respectively) were slightly larger than those for a skilled physical examination (0.917 and 0.898, respectively) (P = NS for both) but were significantly larger than for an aortic valve calcification score also obtained using pocket-sized echocardiography (areas under the curve, 0.816 [P = .0015] and 0.827 [P = .0001], respectively).

Conclusions

A novel and simple method using pocket-sized echocardiography is useful for rapid grading of AS in subjects with systolic ejection murmur.

Section snippets

Subjects and Protocol

We recruited 147 consecutive patients aged >20 years who had SEM with grade ≥2 or known AS and were referred to the echocardiography laboratory at the Osaka City General Hospital. Patients with atrial fibrillation or any other significant murmurs louder than SEM were excluded. Patients were also excluded if there was technical difficulty in observing the aortic valve cusps on pocket-sized echocardiography or in evaluating the aortic valve area (AVA) using the continuity equation with high-end

Results

Of the 147 patients recruited for this study, 86 (59%), 23 (16%), 20 (14%), and 18 (12%) had been referred from the cardiology outpatient department, the cardiology ward, noncardiology outpatient departments, and noncardiology wards, respectively. Among them, 51 (35%) had known AS, and 51 (35%) had some symptoms (dyspnea, palpitations, angina, or syncope), but only eight (5%) were classified in New York Heart Association functional class III or IV. Assessment of visual AS scores with

Discussion

In the present study, we examined the usefulness of our novel and simple method to visually screen for AS using pocket-sized echocardiography. We found that our visual AS score was as accurate as a skilled physical examination for determining the presence of significant AS.

AS is very common in elderly individuals and is potentially fatal soon after or even before the onset of noticeable symptoms.3, 4, 5, 6, 7 Therefore, the early detection of significant AS is very important, and every elderly

Conclusions

Our novel and simple method using pocket-sized echocardiography had as good accuracy in determining if significant AS is present in a subject with SEM as a skilled physical examination. A visual AS score <3 could successfully rule out moderate or severe AS, and a visual AS score ≥4 could successfully rule in severe AS. Thus, pocket-sized echocardiography would be useful in the immediate confirmation of AS diagnosis, brief grading of AS severity, and identification of the urgent need for prompt

References (32)

  • H. Baumgartner et al.

    Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice

    J Am Soc Echocardiogr

    (2009)
  • B. Iung et al.

    A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease

    Eur Heart J

    (2003)
  • J. Ross et al.

    Aortic stenosis

    Circulation

    (1968)
  • C.M. Otto et al.

    Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome

    Circulation

    (1997)
  • R. Rosenhek et al.

    Predictors of outcome in severe, asymptomatic aortic stenosis

    N Engl J Med

    (2000)
  • P.A. Pellikka et al.

    Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up

    Circulation

    (2005)
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