How should I interpret echocardiogram results in a patient suspected of having aortic stenosis?

When interpreting echocardiogram results in a patient suspected of having aortic stenosis (AS), focus on key parameters that define the severity and guide management. The primary echocardiographic measurements include the peak aortic jet velocity (Vmax), mean transvalvular gradient, and aortic valve area (AVA). A Vmax greater than 4 m/s, a mean gradient over 40 mmHg, and an AVA less than 1.0 cm² typically indicate severe AS ¹.

Specifically, NICE guidelines recommend considering intervention in symptomatic patients with severe AS, defined by these echocardiographic criteria, and also in asymptomatic patients if Vmax exceeds 5 m/s, AVA is less than 0.6 cm², or left ventricular ejection fraction (LVEF) is below 55% ¹.

In cases of low-gradient AS with reduced LVEF (<50%), dobutamine stress echocardiography can help differentiate true severe AS from pseudo-severe AS by assessing if the mean gradient increases above 40 mmHg while AVA remains below 1 cm^{2 1}. This approach is supported by literature emphasizing the importance of stress imaging to resolve diagnostic uncertainty in low-flow, low-gradient AS (Messika-Zeitoun et al., 2018).

Additional echocardiographic findings such as left ventricular hypertrophy, impaired systolic function, and valve calcification severity also contribute to the overall assessment and prognosis (Chambers, 2009; Deeprasertkul and Ahmad, 2017). Cardiac CT calcium scoring may be considered if echocardiographic severity is uncertain ¹.

It is important to integrate clinical symptoms (e.g., angina, syncope, breathlessness) with echocardiographic findings, as symptomatic severe AS warrants urgent specialist referral and consideration for valve intervention ¹.

In summary, interpret echocardiogram results by assessing Vmax, mean gradient, AVA, and LVEF, using stress echocardiography when needed, and correlate these with clinical presentation to guide referral and management decisions in line with NICE guidelines and contemporary literature ¹ (Chambers, 2009; Messika-Zeitoun et al., 2018).