Doppler-detected valve movement in aortic stenosis: A predictor of adverse outcome

Abstract

Background The absence of auscultatory aortic valve closure sound is associated with severe aortic stenosis. The absence of Doppler-derived aortic opening (Aop) or closing (Acl) may be a sign of advanced severe aortic stenosis. Hypothesis Absent Doppler-detected Aop or Acl transient is indicative of very severe aortic stenosis and is associated with adverse outcome. Methods A total of 118 consecutive patients with moderate (n = 63) or severe aortic stenosis (n = 55) were included. A op and Acl signals were identified in a blinded fashion by continuous-wave Doppler. Patients with and without Aop and A cl were compared using χ2 test for dichotomous variables and analysis of variance for continuous variables. The associations of Aop and Acl with aortic valve replacement were determined. Results Aop or Acl were absent in 22 of 118 patients. The absence of Aop or Acl was associated with echocardiographic parameters of severe aortic stenosis. The absence of A op or Acl was associated with incident aortic valve replacement (36.4% vs 7.3%, respectively, P < 0.001). Even in patients with aortic valve area <1 cm2, the absence of Aop or A cl was still associated with increased rate of aortic valve replacement (42.1% vs 13.9%, respectively, P = 0.019) and provided incremental predictive value over peak velocity. Conclusions In a typical population of patients with aortic stenosis, approximately 1 in 6 has no detectible aortic valve opening or closing Doppler signal. The absence of an Aop or Acl signal is a highly specific sign of severe aortic stenosis and is associated with incident aortic valve replacement. © 2014 Wiley Periodicals, Inc.