What is the variation in echo estimates?

[67walkon]

One of you knows the answer to this, or at least knows where I can find the answer.

The AV area is apparently estimated based on the gradient across the AV. My "peak gradient" is reported as 50mmHg and my "mean gradient" is reported as 30mmHg, resulting in a "calculated aortic valve area" of 1.0 cm square.

Without a cath or a CT scan, does anyone know how accurate the calculated estimates are? I wasted a lot of time today on the internet trying to figure it out.

I did find AHA guidelines which say that a mean gradient of 25 to 40 translates to a "moderate" degree of stenosis, with an estimated valve area of 1.0 to 1.5. At a mean gradient of 30, it seems to me I should be closer to 1.5 than to 1.0. Somehow 1.3 or so sounds so much more reassuring than 1.0!

Also, has anyone had a 64 slice cat scan done? I serve on some hospital boards at a hospital that doesn't do cardiac surgery and we are getting a new, state of the art 64 slice scanner sometime soon and I could probably get my primary to prescribe a look with it.

This is so up and down! But it is really reassuring to know you're not alone and not plowing new ground!

John

 

[Ross]

Maybe Tobagotwo knows, but to be honest, I've never run across anything to substantiate accuracy. It's always been dependent on the equipment and the person using it, as far as I know.

 

[Ashley]

Hi,

I am not 100% sure this is what you are talking about, but my cath actually showed my valve area to be quite a bit larger than the echo did. The echo was like .67 and the cath showed it to be nearly 1.

Hope that is helpful.

Ashley

 

[67walkon]

Ashley, it certainly gives me hope! I'm asymptomatic and the recent echo estimates me at 1cm; if it is really 1.5 or so, that would be great!

 

[Susan BAV]

My experience was different

My experience was different

My last pre-op echo was several months before my angiogram and then valve replacement, and I was having symptoms which got much worse during those months in between; but I was much worse than the echo showed, by the time the valve actually came out.

The first cardio told me that I "might never need the valve replaced." About six months later, following a cath, other cardios said I had "weeks, not months" to get the valve replaced. When the valve was replaced about a week later, it was in pieces, either a .7 or a .8 (from two different reports -- but the .8 measurement was from when pathology tried to put the pieces back together to measure the crumbly thing).

Those 64 slice cat scans have been highly recommended by several on this site recently. Echos just aren't as reliable for consistent accuracies.

 

[Bina]

John,
my cardio was pushing me into surgery when I was at 1.57cm, I refused. The next year I was at 1.10cm and feeling very tired all the time.
I was still stubborn, so my cardio booked me to "talk" to the surgeon, who was not letting me stall any longer...he booked it for 2 weeks later.
I know I waited too long, my recovery has been very slow.