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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JCDR Research and Publications Private Limited
2017-06-01
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Series: | Journal of Clinical and Diagnostic Research |
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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. |
first_indexed | 2024-04-13T17:30:32Z |
format | Article |
id | doaj.art-56e20cbbf36740e897e72b457a2eb1be |
institution | Directory Open Access Journal |
issn | 2249-782X 0973-709X |
language | English |
last_indexed | 2024-04-13T17:30:32Z |
publishDate | 2017-06-01 |
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record_format | Article |
series | Journal of Clinical and Diagnostic Research |
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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