From the Guidelines
Aortic stenosis diagnosis should be primarily based on echocardiography, which is the gold standard diagnostic test, providing measurements of valve area, mean pressure gradient, and peak jet velocity. The diagnosis of aortic stenosis typically starts with a clinical evaluation and physical examination to identify symptoms and signs suggestive of the condition, such as exertional dyspnea, angina, syncope, or heart failure, and a harsh systolic murmur at the right upper sternal border that radiates to the carotid arteries, along with a delayed and diminished carotid pulse (pulsus parvus et tardus) 1.
Diagnostic Criteria
The severity of aortic stenosis can be assessed using echocardiography, with severe stenosis defined as a peak velocity > 4.0 m/s, a mean gradient > 40 mm Hg, or valve area < 1.0 cm² when left ventricular systolic function is normal 1. It's also important to consider the patient's symptoms and clinical presentation when interpreting these values.
Imaging Studies
Echocardiography is recommended for the diagnosis and assessment of AS severity, including measurements of valve area, mean transvalvular pressure gradient, and continuity equation valve area 1. Additional testing, such as electrocardiography and cardiac catheterization, may be necessary in certain cases, such as discrepant findings or before valve replacement. CT scanning can also be used to assess valve calcification and anatomy when planning interventions 1.
Monitoring
Regular monitoring with echocardiography is recommended for asymptomatic patients with mild to moderate stenosis, typically every 1-2 years for moderate and 3-5 years for mild stenosis 1. This allows for early detection of changes in disease severity and timely intervention when necessary.
Key Considerations
It's essential to consider the patient's overall clinical presentation, including symptoms, physical examination findings, and imaging study results, when diagnosing and managing aortic stenosis. The use of echocardiography as the primary diagnostic tool, along with regular monitoring and timely intervention, can help improve outcomes for patients with this condition 1.
From the Research
Diagnosis of Aortic Stenosis
- Aortic stenosis is a common disease that can be difficult to diagnose due to its asymptomatic nature and confounding association with other conditions such as arterial hypertension, coronary artery disease, and systemic arteriosclerosis 2.
- The diagnosis of aortic stenosis is typically made using Doppler echocardiography, which plays a pivotal role in confirming the diagnosis, assessing the severity of the disease, and providing prognostically relevant information 2, 3.
- Echocardiography is the key tool for the diagnosis and evaluation of aortic stenosis, and standards should be adopted to maintain accuracy and consistency across echocardiographic laboratories 3.
Screening for Aortic Stenosis
- Screening for aortic stenosis can be done using physical examination and echocardiography, with a focus on detecting a systolic ejection murmur (SEM) 4.
- Further physical examination and/or focused cardiac ultrasound (FoCUS) can be used to determine whether patients with a SEM should be referred for standard echocardiography 4.
- Visual AS and calcification scores are good objective parameters in screening for AS with FoCUS, and can help identify patients with severe AS or a high probability of AS-related events 4.
Assessment of Aortic Stenosis Severity
- The severity of aortic stenosis can be assessed using echocardiography, with a focus on optimizing left ventricular outflow tract assessment, low flow, low gradient aortic stenosis with preserved ejection fraction, and a new classification of aortic stenosis by gradient, flow, and ejection fraction 3.
- A grading algorithm can be used for an integrated and stepwise approach to aortic stenosis assessment in clinical practice 3.
- Serial Doppler echocardiography is recommended for asymptomatic patients with aortic stenosis, with the frequency of monitoring depending on the severity of the disease 5.