New "standards" of measuring heart valve openings... So now I am a 1.5 not 1.0!?!?

[DeuxofUs]

New "standards" of measuring heart valve openings... So now I am a 1.5 not 1.0!?!?

I go every 6 months to get my heart checked. So I have been holding steady at 1.0 aotic opening but now my cardio put me at a 1.5. Ok. um.... she said that the Heart Association gets together every so often and compares notes, studies, etc and "tweaks" their numbers. She is telling me that they were overestimating before and now they have changed their measuring system.

THis is REALLY messing with my head. Has anyone heard of this??????

 

[Julian]

I go every 6 months to get my heart checked. So I have been holding steady at 1.0 aotic opening but now my cardio put me at a 1.5. Ok. um.... she said that the Heart Association gets together every so often and compares notes, studies, etc and "tweaks" their numbers. She is telling me that they were overestimating before and now they have changed their measuring system.

THis is REALLY messing with my head. Has anyone heard of this??????

Grrr... I've shared my experience with echo numbers before and i'm not too keen on em'. In the same year my echo numbers were .7 to 1.6... Different docs different techs. I would get a second opinion or even a third. Hope you don't feel any symptoms. I truly hope this 1.5 is true because then you will be in good shape, no surgery for awhile. Just amazes me how you can go from severe to mild/moderate with a meeting with the other chiefs of medicine.

 

[epstns]

One question, Deux -- When the doc's got together to re-define how they will measure average valve area, did they also re-define the valve areas that denote the degrees of severity? In other words, if 1.0 used to be considered "severe" is the new measure at 1.5 also considered "severe" or did they just downgrade everyone's conditions?

 

[skeptic49]

The ACC/AHA guidelines for the treatment of valvular disease were last published in 2006 with a focused update in 2008. I cannot find any later changes or updates. See

http://my.americanheart.org/profess...CCAHA-Joint-Guidelines_UCM_321694_Article.jsp

Jim

 

[tobagotwo]

I think it sounds like baloney. I think if someone was given a bad read (or an incorrect interpretation of a read), the cardiologist may feel like she needs to have an explanation for the difference in the new read that doesn't make the practice look foolish. I would definitely get an echo from a separate source to check it. It may be time to ask how many AS patients have been treated there. There are a lot of cardiologists who just don't seem to have much experience with stenotic aortic valve patients, and can make basic errors (or have less than perfectly competent sonography techs).

A check of the ASE site (the American Society of Echocardiography) at http://www.asecho.org/i4a/pages/index.cfm?pageid=3317#Valves shows nothing new other than a blurb about transcatheter valve replacements, which have nothing to do with estimaitng valve size.

In both of my surgeries, the catheter measurement and the echo measurement were very close to each other, and mostly agreed with the surgeon's visual examination, excepting that in each case, the opening was actually deemed slightly smaller than the estimated sizes, rather than larger as your cardio seems to be suggesting. Can't "tweak" the physical examination of the valve at removal.

A .5 cm² difference is huge when you're at this stage of stenosis. 1.5 cm² is ony moderate stenosis. 1.0 cm² is severe stenosis, and anything below 1.0 cm² is considered operable. If the standards were that different, how could they have been managing all these valve surgeries all these years? Wouldn't they have noticed it before now that they were always .5 cm² off?

Obviously, I can't prove this, but I would like to hear the explanation that would make it otherwise.

Best wishes,

 

[Mentu]

I find this a little disturbing, also, because my experience was similar to Bob's. In Nov 08 after an echocardiogram, my valve area was measured at 1.25 cm2. My life was already seriously effected by some of the symptoms such as shortness of breath, loss of energy and the beginning of heart palpitations. By Jun 09 my symptoms were worse and the palpitations were coming at night and during the day and leaving me exhausted after each bout. A new echocardiogram that month produced calculations for my valve area of 0.75 cm2. When he saw the difference in calculated valve area, My Cardiologist was skeptical of the 0.75 cm2 but he is a good doctor so he ordered a heart cath. The heart cath a month later produced a more accurate reading of 0.71 cm2 which was very close to the June measurement considering the margin of error for echocardiograms. My AVR followed in September. I agree with the others that you might want to consider a second opinion.

Larry

 

[DeuxofUs]

Steve,

The answer is that it was downgraded for everyone. She said "they" were over compensating and have recalculated the numbers.

THe last two times I had the same tech do the echo. She has been doing it for 35 years. The first time I had it done, it was 1.6. Then a year later it was 1.0... 6 months later it was exactly the same and another 6 months it's now it's back to 1.5 as she said due to the changes...

I'm going for a second opinion. This is nuts.

 

[ottagal]

I have another thought. Are they downgrading it because they are now indexing it to your 'body size/mass"? My understanding is that a measurement of 1 cm2 for an aortic valve in a 6 foot 2 inch male 220 pound male is quite different from a measurement of 1 cm2 for an aortic valve in a 5 foot, 95 pound female.
However, I always thought symptoms and aortic jet velocity (among other factors) were taken into account to determine when to operate as well as severity. The 2008 Guidelines should also help you.

I agree with what everyone else is saying!

Good luck.

 

[DeuxofUs]

I have another thought. Are they downgrading it because they are now indexing it to your 'body size/mass"? My understanding is that a measurement of 1 cm2 for an aortic valve in a 6 foot 2 inch male 220 pound male is quite different from a measurement of 1 cm2 for an aortic valve in a 5 foot, 95 pound female.
However, I always thought symptoms and aortic jet velocity (among other factors) were taken into account to determine when to operate as well as severity. The 2008 Guidelines should also help you.

I agree with what everyone else is saying!

Good luck.

I'm not sure if that's the reason. The good news is that the other parts of my heart.. numbers wise are pretty good. Still, I am going to call a new cardio on Monday and get a second opinion.

 

[tobagotwo]

A couple of possible, partial explanation, if she explained it in a confusing way...

1: Your AS would have been downgraded from Severe (1.0 cm²) to Moderate (1.5cm² ) by the change in readings. But then, which reading should you trust?

2: Also, a number of cardiological practices have determined that the valve opening can get smaller than they uset to allow. It used to be .9 cm² or smaller was considered good to operate by just about everyone. Now a lot of them have changed to allow them to go down to .7 cm² or even .6 cm². Of course, you can't do that if your tech can't get successive readings within .5 cm².

However, most patients are in their mid-70s, with decreased activity. An active 70+ year-old, or a younger person risks perrmament damage to the heart (or sudden death) at that small an opening. I betcha the cardiothoracic surgeons aren't very happy with it, if this is the case.

Allowing more AV areas to go smaller may be a downgrading of surgical necessity, but it has absolutely no bearing on the measurement of the valve area via echocardiography. It in no way explains the differences in the echo results. (The way you're lying on your side, the pressure or angle the tech is using, the equipment, or the tech's math can affect the outcomes - but it should never be by that much.)

Best wishes,

 

[Lynlw]

A couple of possible, partial explanation, if she explained it in a confusing way...

1: Your AS would have been downgraded from Severe (1.0 cm²) to Moderate (1.5cm² ) by the change in readings. But then, which reading should you trust?

2: Also, a number of cardiological practices have determined that the valve opening can get smaller than they uset to allow. It used to be .9 cm² or smaller was considered good to operate by just about everyone. Now a lot of them have changed to allow them to go down to .7 cm² or even .6 cm². Of course, you can't do that if your tech can't get successive readings within .5 cm².

However, most patients are in their mid-70s, with decreased activity. An active 70+ year-old, or a younger person risks perrmament damage to the heart (or sudden death) at that small an opening. I betcha the cardiothoracic surgeons aren't very happy with it, if this is the case.

Allowing more AV areas to go smaller may be a downgrading of surgical necessity, but it has absolutely no bearing on the measurement of the valve area via echocardiography. It in no way explains the differences in the echo results. (The way you're lying on your side, the pressure or angle the tech is using, the equipment, or the tech's math can affect the outcomes - but it should never be by that much.)

Best wishes,

I agree with everything bob has said in this thread I do have a question tho. before your echo that showed it at1 wasnt it somthing like 1.7 (close to what this one says) and everyone wonderred why it dropped that bad so shortly? maybe that was the bad reading and youve been stable at the 1.7 1.5 range all along and they are just trying to cover something. would be my questons to the doc.

 

[Bill B]

I don't think you can draw any concrete conclusions from 2 echos. I had one echo interpreted as showing perivalvular leak - a potentially serious complication. A repeat echo was interpreted as showing no leak. A re-reading of the first echo by a different cardiologist reported no leak. Worse than that is the cardiologist William Davis who runs an online "Track Your Plaque" business that sells testing and "heart health" supplements. He publishes anecdotal reports of improvement in aortic stenosis and regurgitation in patients to whom he has prescribed vitamin D or vitamin K2 every so often on his blog site, based on a change in interpretation between two echo tests. He never reports any of his patients who don't show a positive change and he never has published any long-term follow-up of the positive patients beyond the single echo interval.

Echo test results are dependent on technician consistency, cardiologist interpretation skill and some mathematical extrapolations that may not always reflect reality. There are several ways to calculate valve area. Direct measurement by outlining the valve in systole is not used - that is considered the most inaccurate method. Instead there are formulas that derive area form flow and pressure gradient measurements, which in themselves are not directly measured but are calculated from measurements of cardiac output (which is not directly measured), heart rate and systolic ejection time. If there has been a recent change in the protocol, it's been kept a pretty good secret.