Abstract 8978: Echocardiographic Surveillance of Aortic Valve Stenosis: an Audit and Retrospective Analysis.
Introduction: Guidelines have been formulated by several authorities regarding frequency of echo surveillance for valve diseases. There is however considerable variation between different guidelines, with guidance on mild disease often being ambiguous.
Objectives: Our primary objective was to audit echo surveillance of aortic stenosis (AS) in our institution with reference to published guidelines. Our secondary objective was to retrospectively analyze data on AS to assess rate of progression in our population, with particular emphasis on mild AS.
Methods: Audit standards were derived from guidelines issued in Britain, Europe and the USA. Final audit standards were: 6–12 monthly echo for severe AS, 1–2 yearly for moderate, and 3–5 yearly for mild AS. Timing of 126 echos was compared with audit standards. Rate of progression of AS was calculated from the above data. 73 further echos were analyzed to assess progression of mild AS.
Results: 83/126 (65.9%) echos were appropriately timed. 26/50 (52.0%) for follow up of severe AS were appropriate, 48/56 (85.7%) for moderate AS, and 9/20 (45.0%) for mild AS. 73/112 (65.2%) echos requested by a cardiologist and 10/14 (71.4%) requested by a non-cardiologist were appropriate. Mean reduction in effective orifice area was 0.11cm2/year and increase in peak gradient was 5.06mmHg/year. Data on mild AS demonstrated a change of grade in 50/73 (68.5%) cases over a mean follow up of 18.2 months, with 40/73 (54.8%) progressing to moderate and 9/73 (12.3%) to severe AS.
Conclusions: In our institution there were a substantial number of inappropriately timed echos, with surveillance of severe and mild AS performed least well. Performances of cardiologists and non-cardiologists were similar. To ensure adequate patient monitoring and to avoid unnecessary use of resources, standards for timing of follow up echo have been agreed locally and are being re-audited. Rates of progression of AS in our population are in line with published values. A majority of cases of mild AS had progressed to more severe grades of stenosis over a mean interval of 18.2 months. We therefore have concerns that ambiguities in guidelines may lead clinicians to consider follow up of mild AS inappropriate, and would advocate periodic echo evaluation for such patients.
- © 2010 by American Heart Association, Inc.