Advantages of Multiposition Scanning in Echocardiographic Assessment of the Severity of Discordant Aortic Stenosis

Elena Zelikovna Golukhova; Inessa Viktorovna Slivneva; Inga Yur'evna Farulova; Ivan Ivanovich Skopin; Damir Ildarovich Marapov; Dar'ya Vladimirovna Murysova; Yuliya Dmitrievna Pirushkina; Irina Vasilyevna Volkovskaya

doi:10.3390/pathophysiology30020015

Advantages of Multiposition Scanning in Echocardiographic Assessment of the Severity of Discordant Aortic Stenosis

Pathophysiology. 2023 Apr 26;30(2):174-185. doi: 10.3390/pathophysiology30020015.

Authors

Elena Zelikovna Golukhova¹, Inessa Viktorovna Slivneva², Inga Yur'evna Farulova³, Ivan Ivanovich Skopin³, Damir Ildarovich Marapov⁴, Dar'ya Vladimirovna Murysova³, Yuliya Dmitrievna Pirushkina⁵, Irina Vasilyevna Volkovskaya⁶

Affiliations

¹ A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
² Department of Cardiovascular and Comorbid Pathology, A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
³ Department of Reconstructive Surgery of Heart Valves and Coronary Arteries, A.N. Bakulev National Medical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
⁴ Department of Public Health, Economics and Health Care Management, Kazan State Medical Academy-Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education, Russian Medical Academy of Continuous Professional Education, Ministry of Healthcare of the Russian Federation, 420012 Kazan, Russia.
⁵ Department of Cardiology and Functional Diagnostics, A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.
⁶ Polyclinic Department of the Institute of Coronary and Vascular Surgery, A.N. Bakulev National Medical Scientific Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, 121552 Moscow, Russia.

Abstract

Aim of the study: The aim of this study was to perform a comparative analysis of severity of discordant aortic stenosis (AS) assessment using multiposition scanning and the standard apical window.

Materials and methods: All patients (n = 104) underwent preoperative transthoracic echocardiography (TTE) and were ranked according to the degree of AS severity. The reproducibility feasibility of the right parasternal window (RPW) was 75.0% (n = 78). The mean age of the patients was 64 years, and 40 (51.3%) were female. In 25 cases, low gradients were identified from the apical window not corresponding to the visual structural changes in the aortic valve, or disagreement between the velocity and calculated parameters was detected. Patients were divided into two groups: concordant AS (n = 56; 71.8%) and discordant AS (n = 22; 28.2%). Three individuals were excluded from the discordant AS group due to the presence of moderate stenosis.

Results: Based on the comparative analysis of transvalvular flow velocities obtained from multiposition scanning, the concordance group showed agreement between the velocity and calculated parameters. We observed an increase in the mean transvalvular pressure gradient (ΔP_mean) and peak aortic jet velocity (V_max), ΔP_mean in 95.5% of patients, velocity time integral of transvalvular flow (VTI AV) in 90.9% of patients, and a decrease in aortic valve area (AVA) and indexed AVA in 90.9% of patients after applying RPW in all patients with discordant AS. The use of RPW allowed the reclassification of AS severity from discordant to concordant high-gradient AS in 88% of low-gradient AS cases.

Conclusion: Underestimation of flow velocity and overestimation of AVA using the apical window may lead to misclassification of AS. The use of RPW helps to match the degree of AS severity with the velocity characteristics and reduce the number of low-gradient AS cases.

Keywords: TTE; aortic root angulation; discordant aortic stenosis; multiple-view scanning of aortic valve; reclassification of aortic stenosis; right parasternal window; transthoracic echocardiography.

Grants and funding

This research received no external funding.