ASE: Severe aortic stenosis often under-diagnosed

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Symptoms of severe aortic stenosis are under-diagnosed, preventing patients from receiving potentially life-saving aortic valve replacement (AVR) surgery, according to research presented Tuesday at the American Society of Echocardiography (ASE) meeting in Washington, D.C. By using cardiovascular ultrasound and other objective tests, physicians can more accurately diagnose symptoms of severe aortic stenosis and help prevent the rapid progression of the disease.

"It is well known that severe aortic stenosis is a life-threatening condition," said the study's lead author, Benjamin H. Freed, MD, of the University of Chicago Medical Center. "Patients are not being referred for aortic valve replacement surgery because symptoms of aortic stenosis are not being identified or are not attributed to aortic stenosis. As a result, surgery in these patients is frequently delayed or not performed. This could be resolved by using objective tests, such as calcium assessment with echocardiography to diagnose symptoms and predict rapid progression of the disease."

The researchers examined 106 patients and found that only 25 percent with severe aortic stenosis were referred for surgery. The other 75 percent did not have AVR surgery even though they met echocardiographic criteria (AVA less than 1 cm2, aortic valve gradient more than 40 mmHg). Of the patients who did not have surgery, 42 percent were symptomatic.

They reported that the most common reason patients with symptomatic, severe aortic stenosis did not receive AVR was because symptoms were thought to be unrelated to aortic stenosis. Fifteen percent of those patients later died.

Based on their findings, the investigators recommended that patients with suspected aortic stenosis should talk to their doctors about whether they need an echocardiogram or other diagnostic tests. Patients with existing aortic stenosis should monitor their condition carefully and if it becomes severe, they should discuss their options for AVR surgery with their doctor.