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Additive value of the right parasternal window for the assessment of aortic stenosis
  • +8
  • Masaki Izumo,
  • Toshio Shimamura,
  • Sato Yukio,
  • Noriko Shiokawa,
  • Niina Uenomachi,
  • Motoki Miyauchi,
  • Junko Miyamoto,
  • Hidekazu Kikuchi,
  • Junko Shinoda,
  • Takanori Okamura,
  • Yoshihiro Akashi
Masaki Izumo
Sei Marianna Ika Daigaku Naikagaku Junkanki Naika

Corresponding Author:[email protected]

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Toshio Shimamura
Sei Marianna Ika Daigaku Byoin
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Sato Yukio
Sei Marianna Ika Daigaku Naikagaku Junkanki Naika
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Noriko Shiokawa
Sei Marianna Ika Daigaku Byoin
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Niina Uenomachi
Sei Marianna Ika Daigaku Byoin
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Motoki Miyauchi
Sei Marianna Ika Daigaku Byoin
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Junko Miyamoto
Sei Marianna Ika Daigaku Byoin
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Hidekazu Kikuchi
Sei Marianna Ika Daigaku Byoin
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Junko Shinoda
Sei Marianna Ika Daigaku Byoin
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Takanori Okamura
Sei Marianna Ika Daigaku Byoin
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Yoshihiro Akashi
Sei Marianna Ika Daigaku Naikagaku Junkanki Naika
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Abstract

Background: Although Doppler evaluation using a multiplanar method is recommended to assess the severity of aortic stenosis (AS) with transthoracic echocardiography, evidence on the diagnostic significance of a non-apical method is limited. This study aimed to compare the use of the apical window (AW) with use of the right parasternal window (RW) method to evaluate AS severity and to examine the diagnostic significance of performing the RW method in addition to the AW method during the evaluation. Methods: This retrospective observational study included 287 consecutive patients (mean age: 79 ± 10 years; women, 56%) with severe AS (aortic valve area [AVA] ≤1.0cm 2). The severity of AS according to the AW method and that according to the RW for all subjects were compared, and the significance of performing the RW method in addition to the AW method was examined. Furthermore, we compared the concordance group, in which the AW and RW methods indicated matching in severity, and the discordant group, in which the AW and RW methods did not indicate matching severity. Results: Peak velocity (PV), mean pressure gradient (PG), and AVA were not significantly different between the AW and RW methods. Performing the RW method in addition to the AW method significantly decreased the number of low PG AS cases (mean PG <40 mmHg) from 71.1% to 65.0% and it increased the number of very severe AS cases (PV ≥5m/s) from 8.7% to 14.5%. Although, there was no significant difference in the Doppler angle (DA) observed using the AW method for the discordant group and the concordant group, the DA observed using the RW method was significantly smaller in the discordant group (8.8±8.2, 16.3±12.3 °, p<0.01). In the receiver-operating characteristic analysis, with the RW method, a DA of 8° was the cutoff value for discrepancies between the two groups. Conclusions: By performing the RW method in addition to the AW method to determine AS severity, different severity is observed in approximately 10% of cases. These results suggest that AS severity may be underestimated by using the AW method alone.
30 May 2022Submitted to Echocardiography
31 May 2022Submission Checks Completed
31 May 2022Assigned to Editor
06 Jun 2022Reviewer(s) Assigned
28 Jun 2022Review(s) Completed, Editorial Evaluation Pending
03 Jul 2022Editorial Decision: Revise Major
15 Aug 20221st Revision Received
17 Aug 2022Submission Checks Completed
17 Aug 2022Assigned to Editor
17 Aug 2022Reviewer(s) Assigned
24 Aug 2022Review(s) Completed, Editorial Evaluation Pending
30 Aug 2022Editorial Decision: Revise Minor
01 Sep 20222nd Revision Received
01 Sep 2022Submission Checks Completed
01 Sep 2022Assigned to Editor
05 Sep 2022Reviewer(s) Assigned
12 Sep 2022Review(s) Completed, Editorial Evaluation Pending
17 Sep 2022Editorial Decision: Accept