Diagnostics

Echo

• Indication: assessment of aortic valve structure, function, and stenosis severity, left ventricle and other heart valves

  • TTE: recommended primary test and noninvasive gold standard used to confirm diagnosis and determine AS severity

  • TEE: second-line modality for confirmation of TTE findings or operative planning

• Supportive findings

  • Calcification and narrowing of the aortic valve

  • Increased mean aortic pressure gradient and transvalvular velocity

  • Signs of cardiac remodeling, e.g., concentric hypertrophy

• ECG

  • ECG signs of LVH (e.g., positive Sokolow-Lyon index)

    • Nonspecific ST-segment and T-wave abnormalities

• Chest x-ray: Used to assess for pulmonary edema or other causes of dyspnea.

  • Visible calcifications within the aortic valve may indicate more severe disease.

  • Narrowing of retrocardiac space (lateral view)

  • Signs of cardiac remodeling and associated heart failure: x-ray signs of LVH, pulmonary congestion, poststenotic dilation of the aorta

• Diagnostic cardiac catheterization: an accurate diagnostic test for the evaluation of aortic valve area, cardiac output, and mean aortic pressure gradient (not routinely indicated)

  • Consider in symptomatic patients with inconclusive noninvasive testing or discrepancy between symptoms and noninvasive testing.

  • Findings: similar to echocardiographic findings