Question 6#
A 68-year-old man is referred for assessment of an ejection systolic murmur after presenting with worsening breathlessness. Image loops taken from his transthoracic echocardiogram are shown
The following measurements were obtained during transthoracic echo:
- mean gradient across aortic valve, 30 mmHg
- aortic valve area (by continuity equation), 1.0 cm2
Coronary angiography demonstrated mild atheroma without any significant disease.
Which one of the following would be the most useful next investigation?
A. Repeat transthoracic echocardiogram in 6 monthsB. Transoesophageal echocardiography
C. Dobutamine stress echocardiography
D. Exercise tolerance test for risk stratification
E. Repeat transthoracic echocardiogram in 12 months
Correct Answer is C
Comment:
This patient has a small aortic valve area and a modest peak gradient in the context of LV impairment (low flow, low gradient AS). In this subset of individuals low-dose dobutamine stress echocardiography can help to distinguish truly severe AS from pseudo-severe AS.
- True AS: there would be little change in valve area (<0.2 cm2 and remaining <1.1 cm2 ) but a significant increase in aortic valve gradients
- Pseudo-severe AS: the valve area becomes bigger.