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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
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Diagnostic evaluation of patients with aortic stenosis

Diagnostic evaluation of patients with aortic stenosis
Patient characteristics Test Evaluation Comments
Signs or symptoms of aortic stenosis Transthoracic echocardiogram[1]
  • Evaluate valve anatomy
  • Measure valve hemodynamics
  • Evaluate left ventricular size and systolic function
Follow-up transthoracic echocardiogram:
  • Changing signs or symptoms
  • Stable patients with AS:
    • Every three to five years for Stage B mild AS (transvalvular velocity 2 to 2.9 m/s)
    • Every one to two years for Stage B moderate AS (transvalvular velocity 3 to 3.9 m/s)
    • Every 6 to 12 months with Stage C severe AS (transvalvular velocity 4 m/s or higher)
Calcified valve with reduced systolic opening, LVEF <50 percent, calculated aortic valve area 1.0 cm2 or less AND transvalvular Vmax <4 m/s Low-dose dobutamine stress echocardiogram[1] Severe AS is present if velocity increases to 4 m/s or higher (mean gradient 40 mmHg or higher) with an AVA of 1.0 cm2 or less  
Nondiagnostic echocardigram or discrepancy between clinical and echocardiogram findings Cardiac catheterization[1]

Evaluate transaortic pressure gradient with calculation of valve area as well as pulmonary artery pressures and pulmonary vascular resistance

  

Asymptomatic severe AS to confirm absence of symptoms 

  Exercise testing[1]

Determine exercise duration and blood pressure response to exercise

Determine whether provoked symptoms are equivalent to previously unrecognized or new symptoms

 Exercise testing is contraindicated in symptomatic severe AS
Patient being considered for transcatheter aortic valve replacement Computed tomography[2]

Evaluation of left ventricular outflow tract and annulus shape and size for valve sizing, leaflet length and calcification, and annular to coronary ostial distance

3D TEE is used for this evaluation at some centers

TEE is used for intraprocedural guidance
AS: aortic stenosis; LVEF: left ventricular ejection fraction; AVA: aortic valve area; TEE: transesophageal echocardiogram; TTE: transthoracic echocardiogram.
References:
  1. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63:2438.
  2. Achenbach S, Delgado V, Hausleiter J, et al. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 2012; 6:366.
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