
Objective To obtain reference values of aortic valve area (AVA) in a large population and to infer the risk of overestimating aortic stenosis (AS) when focusing on flow-corrected indices of severity. Methods We prospectively measured indices of AS in all consecutive echocardiograms performed in a large referral cardiac imaging laboratory for 1 year. We specifically analysed the distribution of AVA, indexed AVA and velocity ratio (Vratio) in patients with and without AS, the latter defined as the coexistence of valvular outflow obstruction (Vmax ≥2.5 m/s) and morphological findings of valve degeneration. Results 16 156 echocardiograms were analysed, 14 669 of which did not show valvular obstruction (peak jet velocity <2.5 m/s). In the latter group, AVA was 2.6±0.7 cm2 in 8190 studies with normal valves and 2.3±0.7 cm2 in 6479 studies with aortic sclerosis (AScl). There was a relatively wide overlap between values of AVA, indexed AVA and velocity ratio between studies of patients with AScl and AS. Values of AVA ≤1.0 cm2 were found in 0.5% of studies with normal valves and 1.8% of studies with AScl. These proportions were 3.1% and 9.3% for AVA ≤1.5 cm2, respectively. Vratio ≤0.25 were found in 0.1% of patients without obstruction. Risk factors for a small AVA in patients without obstruction were AScl, female sex, small body surface area, low ejection fraction and mitral regurgitation. Conclusions Normal values of continuity-equation derived AVA are smaller than previously considered. AVA values below cutoffs of moderate or severe AS can be found in patients without the disease. Flow-corrected indices may overestimate AS in patients with low gradients, particularly in the presence of well-identified risk factors.
Adult, Aged, 80 and over, Male, cardiac imaging and diagnostics, aortic stenosis, Aortic Valve Stenosis, Organ Size, Middle Aged, Risk Assessment, Severity of Illness Index, valvular heart disease, Echocardiography, Reference Values, Risk Factors, Valvular Heart Disease, Aortic Valve, echocardiography, Humans, Female, Prospective Studies, Aged
Adult, Aged, 80 and over, Male, cardiac imaging and diagnostics, aortic stenosis, Aortic Valve Stenosis, Organ Size, Middle Aged, Risk Assessment, Severity of Illness Index, valvular heart disease, Echocardiography, Reference Values, Risk Factors, Valvular Heart Disease, Aortic Valve, echocardiography, Humans, Female, Prospective Studies, Aged
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