Identification of Factors that Predict whether the Right Parasternal View Is Required for Accurate Evaluation of Aortic Stenosis Severity
Background To accurately assess aortic stenosis (AS) severity, multiple windows should be used to best align the Doppler beam with the flow direction of the stenotic jet. To evaluate: (1) the frequency at which the highest peak AV velocity is found in the right parasternal window (RPW), (2) the exte...
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| Veröffentlicht in: | Echocardiography (Mount Kisco, N.Y.) N.Y.), 2016-06, Vol.33 (6), p.830-837 |
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| container_title | Echocardiography (Mount Kisco, N.Y.) |
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| creator | Cho, Eun Jeong Kim, Sung-Mok Park, Sung-Ji Lee, Sang-Chol Park, Seung Woo |
| description | Background
To accurately assess aortic stenosis (AS) severity, multiple windows should be used to best align the Doppler beam with the flow direction of the stenotic jet. To evaluate: (1) the frequency at which the highest peak AV velocity is found in the right parasternal window (RPW), (2) the extent of correlation between aortic root angulation and the location of the highest peak AV jet velocity, and (3) which patients would benefit most from RPW‐based assessment of AS severity.
Methods
We evaluated AS velocity in the apical window (AW) and RPW by continuous‐wave Doppler (CWD) in 263 patients with more than moderate AS. If the AV was inaccessible by the left parasternal long‐axis view, the aortoseptal angle was measured by echocardiography and a sagittal view of a computed tomography (CT).
Results
Patients were divided into two groups, the RPW group and the AW group. Significant differences were observed between the two groups regarding the sinus of Valsalva diameter, the aortoseptal angle as measured by echocardiography, and the type of valve. The aortoseptal angle as measured by echocardiography was larger in the AW group compared with the RPW group. Aortoseptal angle (P < 0.001) and valve type (P = 0.036) were independent predictors that the highest AV Vmax would be obtained from the RPW.
Conclusions
The right parasternal window must be evaluated to achieve the most accurate assessment of AS severity, especially in patients with an aortoseptal angle |
| doi_str_mv | 10.1111/echo.13181 |
| format | Article |
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To accurately assess aortic stenosis (AS) severity, multiple windows should be used to best align the Doppler beam with the flow direction of the stenotic jet. To evaluate: (1) the frequency at which the highest peak AV velocity is found in the right parasternal window (RPW), (2) the extent of correlation between aortic root angulation and the location of the highest peak AV jet velocity, and (3) which patients would benefit most from RPW‐based assessment of AS severity.
Methods
We evaluated AS velocity in the apical window (AW) and RPW by continuous‐wave Doppler (CWD) in 263 patients with more than moderate AS. If the AV was inaccessible by the left parasternal long‐axis view, the aortoseptal angle was measured by echocardiography and a sagittal view of a computed tomography (CT).
Results
Patients were divided into two groups, the RPW group and the AW group. Significant differences were observed between the two groups regarding the sinus of Valsalva diameter, the aortoseptal angle as measured by echocardiography, and the type of valve. The aortoseptal angle as measured by echocardiography was larger in the AW group compared with the RPW group. Aortoseptal angle (P < 0.001) and valve type (P = 0.036) were independent predictors that the highest AV Vmax would be obtained from the RPW.
Conclusions
The right parasternal window must be evaluated to achieve the most accurate assessment of AS severity, especially in patients with an aortoseptal angle <119° in the parasternal long‐axis view as measured by echocardiography.</description><identifier>ISSN: 0742-2822</identifier><identifier>EISSN: 1540-8175</identifier><identifier>DOI: 10.1111/echo.13181</identifier><identifier>PMID: 26803922</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Aged ; aortic stenosis ; Aortic Valve Stenosis - diagnostic imaging ; aortoseptal angulation ; Doppler echocardiography ; Echocardiography - methods ; Female ; Humans ; Image Enhancement - methods ; Image Interpretation, Computer-Assisted - methods ; Male ; Observer Variation ; Patient Positioning - methods ; peak velocity ; Reproducibility of Results ; Sensitivity and Specificity ; Severity of Illness Index ; Sternum - diagnostic imaging</subject><ispartof>Echocardiography (Mount Kisco, N.Y.), 2016-06, Vol.33 (6), p.830-837</ispartof><rights>2016, Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4701-6232b9dafedf208dc729c32aea21b6ab6a52028d2d01c76b5dd6be4e5a3ce7f23</citedby><cites>FETCH-LOGICAL-c4701-6232b9dafedf208dc729c32aea21b6ab6a52028d2d01c76b5dd6be4e5a3ce7f23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fecho.13181$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fecho.13181$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26803922$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cho, Eun Jeong</creatorcontrib><creatorcontrib>Kim, Sung-Mok</creatorcontrib><creatorcontrib>Park, Sung-Ji</creatorcontrib><creatorcontrib>Lee, Sang-Chol</creatorcontrib><creatorcontrib>Park, Seung Woo</creatorcontrib><title>Identification of Factors that Predict whether the Right Parasternal View Is Required for Accurate Evaluation of Aortic Stenosis Severity</title><title>Echocardiography (Mount Kisco, N.Y.)</title><addtitle>Echocardiography</addtitle><description>Background
To accurately assess aortic stenosis (AS) severity, multiple windows should be used to best align the Doppler beam with the flow direction of the stenotic jet. To evaluate: (1) the frequency at which the highest peak AV velocity is found in the right parasternal window (RPW), (2) the extent of correlation between aortic root angulation and the location of the highest peak AV jet velocity, and (3) which patients would benefit most from RPW‐based assessment of AS severity.
Methods
We evaluated AS velocity in the apical window (AW) and RPW by continuous‐wave Doppler (CWD) in 263 patients with more than moderate AS. If the AV was inaccessible by the left parasternal long‐axis view, the aortoseptal angle was measured by echocardiography and a sagittal view of a computed tomography (CT).
Results
Patients were divided into two groups, the RPW group and the AW group. Significant differences were observed between the two groups regarding the sinus of Valsalva diameter, the aortoseptal angle as measured by echocardiography, and the type of valve. The aortoseptal angle as measured by echocardiography was larger in the AW group compared with the RPW group. Aortoseptal angle (P < 0.001) and valve type (P = 0.036) were independent predictors that the highest AV Vmax would be obtained from the RPW.
Conclusions
The right parasternal window must be evaluated to achieve the most accurate assessment of AS severity, especially in patients with an aortoseptal angle <119° in the parasternal long‐axis view as measured by echocardiography.</description><subject>Aged</subject><subject>aortic stenosis</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>aortoseptal angulation</subject><subject>Doppler echocardiography</subject><subject>Echocardiography - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Image Enhancement - methods</subject><subject>Image Interpretation, Computer-Assisted - methods</subject><subject>Male</subject><subject>Observer Variation</subject><subject>Patient Positioning - methods</subject><subject>peak velocity</subject><subject>Reproducibility of Results</subject><subject>Sensitivity and Specificity</subject><subject>Severity of Illness Index</subject><subject>Sternum - diagnostic imaging</subject><issn>0742-2822</issn><issn>1540-8175</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1uEzEURi0EoqGw4QGQl6jSFNszYzvLKEqbqIVWLX87y2PfYQyTcWt7GvIIfWtc0mYJ1pUs2ef7pKuD0FtKjmk-H8B0_piWVNJnaELrihSSivo5mhBRsYJJxg7Qqxh_EkIEpdVLdMC4JOWUsQm6X1kYkmud0cn5AfsWn2iTfIg4dTrhywDWmYQ3HaQOQn4EfOV-dPlHBx0ThEH3-KuDDV5FfAW3o8sJ3PqAZ8aMQSfAizvdj_v6mQ_JGXydYPDRRXwNdxBc2r5GL1rdR3jzeB-iLyeLz_NlcX5xuprPzgtTCUILzkrWTK1uwbaMSGsEm5qSadCMNlznqRlh0jJLqBG8qa3lDVRQ69KAaFl5iN7vem-Cvx0hJrV20UDf6wH8GBWVRPJSMi7-j4qpFKyseZXRox1qgo8xQKtuglvrsFWUqAdL6sGS-mspw-8ee8dmDXaPPmnJAN0BG9fD9h9VajFfXjyVFruMy1Z-7zM6_FJ5FVGrb59OVbX8WF-eSa6-l38AEZSt9w</recordid><startdate>201606</startdate><enddate>201606</enddate><creator>Cho, Eun Jeong</creator><creator>Kim, Sung-Mok</creator><creator>Park, Sung-Ji</creator><creator>Lee, Sang-Chol</creator><creator>Park, Seung Woo</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope></search><sort><creationdate>201606</creationdate><title>Identification of Factors that Predict whether the Right Parasternal View Is Required for Accurate Evaluation of Aortic Stenosis Severity</title><author>Cho, Eun Jeong ; Kim, Sung-Mok ; Park, Sung-Ji ; Lee, Sang-Chol ; Park, Seung Woo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4701-6232b9dafedf208dc729c32aea21b6ab6a52028d2d01c76b5dd6be4e5a3ce7f23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Aged</topic><topic>aortic stenosis</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>aortoseptal angulation</topic><topic>Doppler echocardiography</topic><topic>Echocardiography - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Image Enhancement - methods</topic><topic>Image Interpretation, Computer-Assisted - methods</topic><topic>Male</topic><topic>Observer Variation</topic><topic>Patient Positioning - methods</topic><topic>peak velocity</topic><topic>Reproducibility of Results</topic><topic>Sensitivity and Specificity</topic><topic>Severity of Illness Index</topic><topic>Sternum - diagnostic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cho, Eun Jeong</creatorcontrib><creatorcontrib>Kim, Sung-Mok</creatorcontrib><creatorcontrib>Park, Sung-Ji</creatorcontrib><creatorcontrib>Lee, Sang-Chol</creatorcontrib><creatorcontrib>Park, Seung Woo</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cho, Eun Jeong</au><au>Kim, Sung-Mok</au><au>Park, Sung-Ji</au><au>Lee, Sang-Chol</au><au>Park, Seung Woo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Identification of Factors that Predict whether the Right Parasternal View Is Required for Accurate Evaluation of Aortic Stenosis Severity</atitle><jtitle>Echocardiography (Mount Kisco, N.Y.)</jtitle><addtitle>Echocardiography</addtitle><date>2016-06</date><risdate>2016</risdate><volume>33</volume><issue>6</issue><spage>830</spage><epage>837</epage><pages>830-837</pages><issn>0742-2822</issn><eissn>1540-8175</eissn><abstract>Background
To accurately assess aortic stenosis (AS) severity, multiple windows should be used to best align the Doppler beam with the flow direction of the stenotic jet. To evaluate: (1) the frequency at which the highest peak AV velocity is found in the right parasternal window (RPW), (2) the extent of correlation between aortic root angulation and the location of the highest peak AV jet velocity, and (3) which patients would benefit most from RPW‐based assessment of AS severity.
Methods
We evaluated AS velocity in the apical window (AW) and RPW by continuous‐wave Doppler (CWD) in 263 patients with more than moderate AS. If the AV was inaccessible by the left parasternal long‐axis view, the aortoseptal angle was measured by echocardiography and a sagittal view of a computed tomography (CT).
Results
Patients were divided into two groups, the RPW group and the AW group. Significant differences were observed between the two groups regarding the sinus of Valsalva diameter, the aortoseptal angle as measured by echocardiography, and the type of valve. The aortoseptal angle as measured by echocardiography was larger in the AW group compared with the RPW group. Aortoseptal angle (P < 0.001) and valve type (P = 0.036) were independent predictors that the highest AV Vmax would be obtained from the RPW.
Conclusions
The right parasternal window must be evaluated to achieve the most accurate assessment of AS severity, especially in patients with an aortoseptal angle <119° in the parasternal long‐axis view as measured by echocardiography.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>26803922</pmid><doi>10.1111/echo.13181</doi><tpages>8</tpages></addata></record> |
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| ispartof | Echocardiography (Mount Kisco, N.Y.), 2016-06, Vol.33 (6), p.830-837 |
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| source | MEDLINE; Wiley Online Library All Journals |
| subjects | Aged aortic stenosis Aortic Valve Stenosis - diagnostic imaging aortoseptal angulation Doppler echocardiography Echocardiography - methods Female Humans Image Enhancement - methods Image Interpretation, Computer-Assisted - methods Male Observer Variation Patient Positioning - methods peak velocity Reproducibility of Results Sensitivity and Specificity Severity of Illness Index Sternum - diagnostic imaging |
| title | Identification of Factors that Predict whether the Right Parasternal View Is Required for Accurate Evaluation of Aortic Stenosis Severity |
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