TY - JOUR
T1 - Improving accuracy in diagnosing aortic stenosis severity
T2 - An in-depth analysis of echocardiographic measurement error through literature review and simulation study
AU - Velders, Bart J. J.
AU - Groenwold, Rolf H. H.
AU - Ajmone Marsan, Nina
AU - Kappetein, Arie-Pieter
AU - Wijngaarden, Rob A. F. De Lind Van
AU - Braun, Jerry
AU - Klautz, Robert J. M.
AU - Vriesendorp, Michiel D.
N1 - Funding Information: Bart J.J. Velders: institutional research grant and speaker fees paid to his department by Medtronic. Rolf H.H. Groenwold: none to declare. Nina Ajmone Marsan: Speaker fees from Ge Healthcare, Philips Ultrasound and Abbott Vascular; research grant from Alnylam. Arie‐Pieter Kappetein: Employee of Medtronic. Rob A.F. De Lind Van Wijngaarden: none to declare. Jerry Braun: none to declare. Robert J.M. Klautz: research support, consultation fees, and European Principal Investigator PERIGON Pivotal Trial for Medtronic. Michiel D. Vriesendorp: institutional research grant and reimbursement of travel expenses from Medtronic. Publisher Copyright: © 2023 The Authors. Echocardiography published by Wiley Periodicals LLC.
PY - 2023/9
Y1 - 2023/9
N2 - Aims: The present guidelines advise replacing the aortic valve for individuals with severe aortic stenosis (AS) based on various echocardiographic parameters. Accurate measurements are essential to avoid misclassification and unnecessary interventions. The objective of this study was to evaluate the influence of measurement error on the echocardiographic evaluation of the severity of AS. Methods and results: A systematic review was performed to examine whether measurement errors are reported in studies focusing on the prognostic value of peak aortic jet velocity (Vmax), mean pressure gradient (MPG), and effective orifice area (EOA) in asymptomatic patients with AS. Out of the 37 studies reviewed, 17 (46%) acknowledged the existence of measurement errors, but none of them utilized methods to address them. Secondly, the magnitude of potential errors was collected from available literature for use in clinical simulations. Interobserver variability ranged between 0.9% and 8.3% for Vmax and MPG but was higher for EOA (range 7.7%-12.7%), indicating lower reliability. Assuming a circular left ventricular outflow tract area led to a median underestimation of EOA by 23% compared to planimetry by other modalities. A clinical simulation resulted in the reclassification of 42% of patients, shifting them from a diagnosis of severe AS to moderate AS. Conclusions: Measurement errors are underreported in studies on echocardiographic assessment of AS severity. These errors can lead to misclassification and misdiagnosis. Clinicians and scientists should be aware of the implications for accurate clinical decision-making and assuring research validity.
AB - Aims: The present guidelines advise replacing the aortic valve for individuals with severe aortic stenosis (AS) based on various echocardiographic parameters. Accurate measurements are essential to avoid misclassification and unnecessary interventions. The objective of this study was to evaluate the influence of measurement error on the echocardiographic evaluation of the severity of AS. Methods and results: A systematic review was performed to examine whether measurement errors are reported in studies focusing on the prognostic value of peak aortic jet velocity (Vmax), mean pressure gradient (MPG), and effective orifice area (EOA) in asymptomatic patients with AS. Out of the 37 studies reviewed, 17 (46%) acknowledged the existence of measurement errors, but none of them utilized methods to address them. Secondly, the magnitude of potential errors was collected from available literature for use in clinical simulations. Interobserver variability ranged between 0.9% and 8.3% for Vmax and MPG but was higher for EOA (range 7.7%-12.7%), indicating lower reliability. Assuming a circular left ventricular outflow tract area led to a median underestimation of EOA by 23% compared to planimetry by other modalities. A clinical simulation resulted in the reclassification of 42% of patients, shifting them from a diagnosis of severe AS to moderate AS. Conclusions: Measurement errors are underreported in studies on echocardiographic assessment of AS severity. These errors can lead to misclassification and misdiagnosis. Clinicians and scientists should be aware of the implications for accurate clinical decision-making and assuring research validity.
KW - aortic stenosis
KW - echocardiography
KW - misclassification
KW - random/systematic measurement error
UR - http://www.scopus.com/inward/record.url?scp=85166436073&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/echo.15664
DO - https://doi.org/10.1111/echo.15664
M3 - Review article
C2 - 37519290
SN - 0742-2822
VL - 40
SP - 892
EP - 902
JO - Echocardiography
JF - Echocardiography
IS - 9
ER -