European Journal of Echocardiography Advance Access published online on December 8, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen303
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice
1 University of Muenster, Muenster, Germany
2 Massachusetts General Hospital, Boston, MA, USA
3 Hospital General Universitario Gregorio Marañón, Barcelona, Spain
4 Huy's and St. Thomas' Hospital, London, United Kingdom
5 Hospital Vall D'Hebron, Barcelona, Spain
6 Cleveland Clinic, Cleveland, OH, USA
7 Paris VII Denis Diderot University, Paris, France
8 University of Washington, Seattle, WA, USA
9 Mayo Clinic, Rochester, MN, USA
10 The Methodist Hospital, Houston, TX, USA
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Abbreviations |
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AR = aortic regurgitation
AS = aortic stenosis
AVA = aortic valve area
CSA = cross sectional area
CWD = continuous wave Doppler
D = diameter
HOCM = hypertrophic obstructive cardiomyopathy
LV = left ventricle
LVOT = left ventricular outflow tract
MR = mitral regurgitation
MS = mitral stenosis
MVA = mitral valve area
P = pressure gradient
RV = right ventricle
RVOT = right ventricular outflow tract
SV = stroke volume
TEE = transesophageal echocardiography
T 1/2 = pressure half-time
TR = tricuspid regurgitation
TS = tricuspid stenosis
V = velocity
VSD = ventricular septal defect
VTI = velocity time integral
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I. Introduction |
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Valve stenosis is a common heart disorder and an important cause of cardiovascular morbidity and mortality. Echocardiography has become the key tool for the diagnosis and evaluation of valve disease, and is the primary non-invasive imaging method for valve stenosis assessment. Clinical decision-making is based on echocardiographic assessment
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II. Aortic stenosis |
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A. Causes and anatomic presentation
B. How to assess aortic stenosis (Tables 1 and 2)
B.1.1. Jet velocity
B.1.2. Mean transaortic pressure gradient
B.1.3. Valve area
B.2. Alternate measures of stenosis severity (Level 2 Recommendation = reasonable when additional information is needed in selected patients)
B.2.1. Simplified continuity equation
B.2.2. Velocity ratio
B.2.3. Aortic valve area planimetry
B.3. Experimental descriptors of stenosis severity (Level 3 recommendation = not recommended for routine clinical use)
B.4. Effects of concurrent conditions on assessment of severity
B.4.1. Concurrent left ventricular systolic dysfunction
B.4.2. Exercise stress echocardiography
B.4.3. Left ventricular hypertrophy
B.4.4. Hypertension
B.4.5. Aortic regurgitation
B.4.6. Mitral valve disease
B.4.7. High cardiac output
B.4.8. Ascending aorta
C. How to grade aortic stenosis
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III. Mitral stenosis |
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A. Causes and anatomic presentation
B. How to assess mitral stenosis
B.1. Indices of Stenosis Severity
B.1.1. Pressure gradient (Level 1 Recommendation)
B.1.2. MVA Planimetry (Level 1 Recommendation)
B.1.3. Pressure half-time (Level 1 Recommendation)
B.1.4. Continuity equation (Level 2 Recommendation)
B.1.5. Proximal isovelocity surface area method (Level 2 Recommendation)
B.1.6. Other indices of severity
B.2. Other echocardiographic factors in the evaluation of mitral stenosis
B.2.1. Valve anatomy
B.2.2. Associated lesions
B.3. Stress echocardiography (Level 2 Recommendation)
C. How to grade mitral stenosis
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IV. Tricuspid stenosis |
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A. Causes and anatomic presentation
B. How to assess tricuspid stenosis
C. How to grade tricuspid stenosis
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V. Pulmonic stenosis |
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A. Causes and anatomic presentation
B. How to grade pulmonary stenosis
B.1.1. Pressure gradient
B.1.2. Other indices of severity
B.1.3. Valve anatomy
B.1.4. Associated lesions
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