Doppler echocardiography in adults with symptomatic aortic stenosis. Diagnostic utility and cost-effectiveness
C. M. Otto and A. S. Pearlman
Department of Medicine, University of Washington, Seattle 98195.
To evaluate the diagnostic utility and cost-effectiveness of Doppler
echocardiography in adults with symptomatic aortic stenosis, we performed a
prospective study in which the need for aortic valve replacement (AVR) was
the outcome event. The total sample consisted of 103 adults (mean age, 69
years) undergoing cardiac catheterization for suspected aortic stenosis.
Twenty-six patients (25%) were used as a training set to develop a clinical
prediction rule. (1) If maximum aortic jet velocity (Vmax) was more than
4.0 m/s, AVR was recommended. (2) If Vmax was less than 3.0 m/s, AVR was
not needed. (3) If Vmax was 3.0 to 4.0 m/s and (a) Doppler aortic valve
area (AVA) was 1.0 cm2 or less, AVR was recommended, while (b) if Doppler
AVA was 1.7 cm2 or greater, AVR was not needed, and (c) if Doppler AVA was
1.1 to 1.6 cm2, consideration of the degree of coexisting aortic
insufficiency was necessary. When this rule was applied to the test set (n
= 77), the sensitivity was 98%, with a specificity of 89% and a total error
rate of 3.9%. The approach could have resulted in cost savings between 24%
and 34% compared with an invasive diagnostic approach.
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