Valor de los planos ecocardiográficos no apicales en la reclasificación al alza de la estenosis aórtica

Abstract

Purpose. Primary objective: to determinate the value of non-apical views (right parasternal; RPV, subcostal; SCV and suprasternal notch; SSNV) in the up-grading of patients with aortic stenosis (AS) initially evaluated from apical 5 chamber view (A5CV). Secondary objectives: a) to investigate the feasibility and reproducibility of non-apical views AS appraisal, b) to assess the prognostic relevance of the aforementioned reclassification. Methods. We designed an observational study that included 269 patients (mean age 76±9 years, 44% females) with AS recruited prospectively in whom the stenosis was graded by echocardiography from A5CV and non-apical view. Follow-up was performed by review of medical records and telephone interviews when considered necessary. Results. Feasibility AS assessment from RPV, SCV and SSNV was 78%, 81% and 56%, respectively (SCV vs SSNV, p=0.009). AS were up-graded from non-apical views according to maximal velocity, mean gradient, area and indexed area by 24%, 17%, 24% and 22%, respectively (p<0.0001). Non-apical views reclassified from non-severe to severe AS, from low gradient severe to high gradient severe AS and from non-critical to critical AS 19%, 23% and 3% of cases (p<0.0001). The 4-years hard cardiac events rate was 41% in patients with non-severe AS, 67% in patients with severe AS from non-apical views, 68% in patients with severe AS from A5CV and 80% in patients with severe AS from A5CV and non-apical views (p<0.001). Reproducibility of AS evaluation from non-apical views was fair to excellent (intraclass correlation coefficients: SSNV=0.44, RPV=0.61, SCV=0.92). Conclusion. Assessment of AS from non-apical views is feasible, reproducible and valuable over A5CV so its use is encouraged.