Abstract 3555: Utilization of a New Echocardiographic Screening Tool for the Assessment of Aortic Stenosis in the Setting of Left Ventricular Systolic Dysfunction
Evaluating aortic stenosis (AS) in patients with low left ventricular ejection fraction (LV EF) can pose a diagnostic challenge. Previously, we introduced a new parameter for the assessment of aortic stenosis in the setting of normal left ventricular systolic function (LV EF > 50%), as a distinct, biphasic systolic continuous wave Doppler signal, easily obtained in the proximal descending thoracic aorta. With increasing stenosis, the flow signal in the aorta exhibits an initial peak (S1) representing the effect of valve pliability, the second peak (S2) LV contractility. This study focused on the application of this parameter in patients with LV systolic dysfunction (EF < 50%). Thirteen patients were studied. Seven patients (group 1) with low EF (mean = 37%) but no significant AS (valve area > 1.5 cm2) were compared to 6 patients (group 2) with a similarly low EF, with significant aortic stenosis (valve area < 1.5 cm2). In group 2, an S1/S2 velocity ratio < 0.74 was predictive (83% positive predictive value) of significant aortic valve stenosis compared to the S1/S2 ratio > 0.74 in group 1. Three patients had monophasic signals with no significant stenosis (valve area > 1.5 cm2). The S1/S2 ratio correlated well with AV area calculated by conventional parameters (r2=0.72, see graph)
Aortic stenosis results in a distinct biphasic Doppler signal in the descending aorta.
The signal characteristics are preserved in patients with LV systolic dysfunction and continue to correlate well with conventional assessment of AS.
This parameter appears to be a helpful adjunct in the assessment of aortic stenosis even in the setting of LV systolic dysfunction.