How should I interpret echocardiogram results in a patient suspected of having aortic stenosis?

When interpreting echocardiogram results in a patient suspected of having aortic stenosis (AS), focus on key parameters that define the severity and guide management. The primary echocardiographic measurements include the peak aortic jet velocity (Vmax), mean transvalvular gradient, and aortic valve area (AVA). A Vmax greater than 4 m/s, a mean gradient over 40 mmHg, and an AVA less than 1.0 cmNICE CKS typically indicate severe AS NICE NG208.

Specifically, NICE guidelines recommend considering intervention in symptomatic patients with severe AS, defined by these echocardiographic criteria, and also in asymptomatic patients if Vmax exceeds 5 m/s, AVA is less than 0.6 cmNICE CKS, or left ventricular ejection fraction (LVEF) is below 55% NICE NG208.

In cases of low-gradient AS with reduced LVEF (<50%), dobutamine stress echocardiography can help differentiate true severe AS from pseudo-severe AS by assessing if the mean gradient increases above 40 mmHg while AVA remains below 1 cmNICE CKS NICE NG208. This approach is supported by literature emphasizing the importance of stress imaging to resolve diagnostic uncertainty in low-flow, low-gradient AS Messika-Zeitoun et al. 2018.

Additional echocardiographic findings such as left ventricular hypertrophy, impaired systolic function, and valve calcification severity also contribute to the overall assessment and prognosis Chambers 2009Deeprasertkul & Ahmad 2017. Cardiac CT calcium scoring may be considered if echocardiographic severity is uncertain NICE NG208.

It is important to integrate clinical symptoms (e.g., angina, syncope, breathlessness) with echocardiographic findings, as symptomatic severe AS warrants urgent specialist referral and consideration for valve intervention NICE NG208.

In summary, interpret echocardiogram results by assessing Vmax, mean gradient, AVA, and LVEF, using stress echocardiography when needed, and correlate these with clinical presentation to guide referral and management decisions in line with NICE guidelines and contemporary literature NICE NG208 Chambers 2009Messika-Zeitoun et al. 2018.