Does This Patient Have Aortic Stenosis?
No, this patient does not have aortic stenosis by any current diagnostic criteria. The echocardiographic parameters clearly demonstrate normal aortic valve function with no evidence of stenosis at any severity level.
Echocardiographic Analysis
Aortic Valve Area Assessment
- The aortic valve area is 1.93 cm², which is well above all thresholds for aortic stenosis 1
- Severe AS requires AVA ≤1.0 cm² 1
- Moderate AS requires AVA 1.0-1.5 cm² 2
- Mild AS requires AVA >1.0 cm² but with other abnormal parameters 2
- This patient's AVA of 1.93 cm² is completely normal 2
Gradient Assessment
- Peak aortic velocity is only 1.45 m/s, far below any stenosis threshold 1, 2
- Mean gradient is 8.4 mmHg, which is normal 1, 2
- For comparison, mild AS requires peak velocity ≥3.0 m/s and mean gradient ≥25 mmHg 2
- Severe AS requires peak velocity ≥4.0 m/s or mean gradient ≥40 mmHg 1
Indexed Valve Area
- The indexed AVA is 1.0 cm²/m², which is above the severe AS threshold of <0.6 cm²/m² 1
- Even the more conservative threshold of <0.4 cm²/m² for high-risk patients is not met 3
Velocity Ratio
- The dimensionless velocity index (AVA velocity ratio) is 0.72, which is normal 1
- Severe AS typically shows a velocity ratio <0.25 1
Low Flow Considerations
Stroke Volume Index Assessment
- The stroke volume index is 23.69 ml/m², which indicates low flow (threshold <35 ml/m²) 1
- However, low flow alone does not indicate AS 1
- Low-flow, low-gradient AS requires BOTH low SVI AND AVA <1.0 cm² 1
- This patient has low flow but a normal valve area of 1.93 cm², excluding any form of AS 1
Clinical Pitfall
The low stroke volume index in this patient suggests either:
- Reduced left ventricular systolic function requiring evaluation 1
- Small, hypertrophied ventricle from other causes (hypertension, hypertrophic cardiomyopathy) 1
- Measurement error in LVOT diameter (even small errors significantly affect calculated stroke volume) 1
The low SVI warrants investigation of its cause, but it does not indicate aortic stenosis given the normal valve area and gradients 1.
Definitive Classification
This patient has a normal aortic valve with no evidence of stenosis, sclerosis, or dysfunction based on all standard echocardiographic criteria 1, 2. The valve area, gradients, and velocity measurements are all within normal limits 2.