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...

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Main Authors: K Jayaprakash, VP Dilu, Raju George
Format: Article
Language:English
Published: JCDR Research and Publications Private Limited 2017-06-01
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
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author K Jayaprakash
VP Dilu
Raju George
author_facet K Jayaprakash
VP Dilu
Raju George
author_sort K Jayaprakash
collection DOAJ
description 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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spelling doaj.art-56e20cbbf36740e897e72b457a2eb1be2022-12-22T02:37:35ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2017-06-01116OC29OC3210.7860/JCDR/2017/27147.10045Maximal Aortic Valve Cusp Separation and Severity of Aortic StenosisK Jayaprakash0VP Dilu1Raju George2Additional Professor, Department of Cardiology, Government Medical College, Kottayam, Kerala, India.Chief Interventional Cardiologist, Department of Cardiology, St. John's Hospital, Kattappana, Kerala, India.Professor, Department of Cardiology, Government Medical College, Kottayam, Kerala, India.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.https://jcdr.net/articles/PDF/10045/27147_CE[Ra1]_F(GH)_PF1(RU_VTNE)_PFA(PNE).pdfaortic valve stenosiscontinuity equationechocardiography
spellingShingle K Jayaprakash
VP Dilu
Raju George
Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis
Journal of Clinical and Diagnostic Research
aortic valve stenosis
continuity equation
echocardiography
title Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis
title_full Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis
title_fullStr Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis
title_full_unstemmed Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis
title_short Maximal Aortic Valve Cusp Separation and Severity of Aortic Stenosis
title_sort maximal aortic valve cusp separation and severity of aortic stenosis
topic aortic valve stenosis
continuity equation
echocardiography
url https://jcdr.net/articles/PDF/10045/27147_CE[Ra1]_F(GH)_PF1(RU_VTNE)_PFA(PNE).pdf
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