Improving accuracy in diagnosing aortic stenosis severity: An in-depth analysis of echocardiographic measurement error through literature review and simulation study.

Autor: Velders BJJ; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands., Groenwold RHH; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands., Ajmone Marsan N; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Kappetein AP; Global Clinical Operations, Coronary and Structural Heart, Medtronic, Maastricht, The Netherlands., Wijngaarden RAFLV; Department of Cardiothoracic Surgery, Amsterdam UMC Location AMC, Amsterdam, The Netherlands., Braun J; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands., Klautz RJM; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands., Vriesendorp MD; Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Jazyk: angličtina
Zdroj: Echocardiography (Mount Kisco, N.Y.) [Echocardiography] 2023 Sep; Vol. 40 (9), pp. 892-902. Date of Electronic Publication: 2023 Jul 31.
DOI: 10.1111/echo.15664
Abstrakt: Aims: The present guidelines advise replacing the aortic valve for individuals with severe aortic stenosis (AS) based on various echocardiographic parameters. Accurate measurements are essential to avoid misclassification and unnecessary interventions. The objective of this study was to evaluate the influence of measurement error on the echocardiographic evaluation of the severity of AS.
Methods and Results: A systematic review was performed to examine whether measurement errors are reported in studies focusing on the prognostic value of peak aortic jet velocity (V max ), mean pressure gradient (MPG), and effective orifice area (EOA) in asymptomatic patients with AS. Out of the 37 studies reviewed, 17 (46%) acknowledged the existence of measurement errors, but none of them utilized methods to address them. Secondly, the magnitude of potential errors was collected from available literature for use in clinical simulations. Interobserver variability ranged between 0.9% and 8.3% for V max and MPG but was higher for EOA (range 7.7%-12.7%), indicating lower reliability. Assuming a circular left ventricular outflow tract area led to a median underestimation of EOA by 23% compared to planimetry by other modalities. A clinical simulation resulted in the reclassification of 42% of patients, shifting them from a diagnosis of severe AS to moderate AS.
Conclusions: Measurement errors are underreported in studies on echocardiographic assessment of AS severity. These errors can lead to misclassification and misdiagnosis. Clinicians and scientists should be aware of the implications for accurate clinical decision-making and assuring research validity.
(© 2023 The Authors. Echocardiography published by Wiley Periodicals LLC.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje