Clinical InvestigationValvular Heart DiseaseA Novel and Simple Method Using Pocket-Sized Echocardiography to Screen for Aortic Stenosis
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)
- et al.
Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample
J Am Coll Cardiol
(1993) - et al.
Prognostic value of aortic valve area index in asymptomatic patients with severe aortic stenosis
Am J Cardiol
(2012) - et al.
Value of noninvasive testing in adults with suspected aortic stenosis
Am J Med
(1986) - et al.
Correlation of prevalence and severity of valvular aortic stenosis determined by continuous-wave Doppler echocardiography with physical signs of aortic stenosis in patients aged 62 to 100 years with aortic systolic ejection murmurs
Am J Cardiol
(1987) - et al.
Prevalence and severity of valvular aortic stenosis determined by Doppler echocardiography and its association with echocardiographic and electrocardiographic left ventricular hypertrophy and physical signs of aortic stenosis in elderly patients
Am J Cardiol
(1991) - et al.
Physical examination in valvular aortic stenosis: correlation with stenosis severity and prediction of clinical outcome
Am Heart J
(1999) - et al.
Noninvasive evaluation of the severity of aortic stenosis in adult patients
Am Heart J
(1984) - et al.
Usefulness of a new miniaturized echocardiographic system in outpatient cardiology consultations as an extension of physical examination
J Am Soc Echocardiogr
(2011) - et al.
Task Force 4: training in echocardiography endorsed by the American Society of Echocardiography
J Am Coll Cardiol
(2008) - et al.
Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology
J Am Soc Echocardiogr
(2005)
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice
J Am Soc Echocardiogr
A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease
Eur Heart J
Aortic stenosis
Circulation
Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome
Circulation
Predictors of outcome in severe, asymptomatic aortic stenosis
N Engl J Med
Outcome of 622 adults with asymptomatic, hemodynamically significant aortic stenosis during prolonged follow-up
Circulation
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Simple echocardiographic scoring in screening aortic stenosis with focused cardiac ultrasonography in the emergency department
2021, Journal of CardiologyCitation Excerpt :However, no method has yet been established for the use of FOCUS in the diagnosis of AS. We have previously developed a visual AS score to use as a simple index for AS screening with rapid echocardiography using a pocket-sized device [9]. In that study, we showed a close correlation between the visual AS score and the severity of AS, as evaluated with an aortic valve area index (AVAI).
Assessing the true severity of low-gradient aortic stenosis using resting echocardiography
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2019, Best Practice and Research: Clinical AnaesthesiologyCitation Excerpt :Such measurements are time consuming, fraught with technical challenges, and not feasible in the fast-paced operative environment. Despite these limitations, in a patient with a new found systolic ejection murmur, visual inspection of the aortic valve with observation of the extent of restriction in aortic cusp opening can alert the anesthesiologist to the presence of a hemodynamically significant aortic stenosis [17]. Additionally, measurement of maximal aortic cusp separation (MACS) is a simple method to assess the severity of aortic stenosis with high sensitivity and specificity.
Handheld Echocardiography
2019, Essential Echocardiography: A Companion to Braunwald's Heart DiseaseAccuracy and Efficacy of Hand-Held Echocardiography in Diagnosing Valve Disease: A Systematic Review
2018, American Journal of MedicineCitation Excerpt :Nevertheless, valve cusp morphology, mobility, degree of calcification, and blood flow acceleration on color Doppler can still provide reliable information on stenosis severity.13 Abe et al18 showed in a cohort (N = 130) of patients with systolic ejection murmur that by focusing on aortic cusp mobility, HHE can have excellent accuracy in grading the severity of aortic stenosis. Several other studies have shown that HHE has excellent agreement with transthoracic echocardiography and spectral Doppler in grading valve stenosis, with a tendency to underestimate the severity in a minority of cases.3,12,13