Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis
Introduction: An integrated approach that incorporates two dimensional, M mode and Doppler echocardiographic evaluation has become the standard means for accurate quantification of severity of valvular aortic stenosis. Maximal separation of the aortic valve cusps during systole has been shown to...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2017-06-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://jcdr.net/articles/PDF/10045/27147_CE[Ra1]_F(GH)_PF1(RU_VTNE)_PFA(PNE).pdf |
| Summary: | Introduction: An integrated approach that incorporates two
dimensional, M mode and Doppler echocardiographic evaluation
has become the standard means for accurate quantification of
severity of valvular aortic stenosis. Maximal separation of the
aortic valve cusps during systole has been shown to correlate
well with the severity of aortic stenosis measured by other
echocardiographic parameters.
Aim: To study the correlation between Maximal Aortic valve
Cusp Separation (MACS) and severity of aortic valve stenosis
and to find cut-off values of MACS for detecting severe and
mild aortic stenosis.
Materials and Methods: In the present prospective observational
study, we have compared the accuracy of MACS distance and
the aortic valve area calculated by continuity equation in 59
patients with varying degrees of aortic valve stenosis. Aortic
leaflet separation in M mode was identified as the distance
between the inner edges of the tips of these structures at mid
systole in the parasternal long axis view. Cuspal separation was
also measured in 2D echocardiography from the parasternal
long axis view and the average of the two values was taken
as the MACS. Patients were grouped into mild, moderate and
severe aortic stenosis based on the aortic valve area calculated
by continuity equation. The resultant data regarding maximal
leaflet separation on cross-sectional echocardiogram was then
subjected to linear regression analysis in regard to correlation
with the peak transvalvular aortic gradient as well as the
calculated aortic valve area. A cut-off value for each group was
derived using ROC curve.
Results: There was a strong correlation between MACS and
aortic valve area measured by continuity equation and the peak
and mean transvalvular aortic gradients. Mean MACS was
6.89 mm in severe aortic stenosis, 9.97 mm in moderate aortic
stenosis and 12.36 mm in mild aortic stenosis. MACS below
8.25 mm reliably predicted severe aortic stenosis, with high
sensitivity, specificity and positive predictive value. MACS above
11.25 mm practically ruled out significant aortic stenosis.
Conclusion: Measurement of MACS is a simple echocardiographic method to assess the severity of valvular aortic stenosis, with high sensitivity and specificity. MACS can be extremely
useful in two clinical situations as a simple screening tool for
assessment of stenosis severity and also helps in decision making non invasively when there is discordance between the other
echocardiographic parameters of severity of aortic stenosis. |
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| ISSN: | 2249-782X 0973-709X |