Simple echocardiographic scoring in screening aortic stenosis with focused cardiac ultrasonography in the emergency department. Issue 6 (June 2021) - Furukawa, Atsuko
Highlights: Emergency physicians could assess visual aortic stenosis (AS) scores accurately. A visual AS score <3 could successfully rule out clinically significant AS. A visual AS score ≥3 requires quantitative assessment to evaluate the AS severity. Visual AS scores can detect patients with high probabilities of AS-related events. Abstract: Background: No established methodology exists for diagnosis of aortic stenosis (AS) using focused cardiac ultrasound (FOCUS). We evaluated the diagnostic accuracy of our developed visual AS score for screening AS in an emergency department. Methods: Seventy-two emergency outpatients with suspected cardiovascular disease were studied. Emergency physicians assessed the visual AS score in addition to conducting the standard FOCUS, and then the aortic valve area index (AVAI) was measured by expert sonographers in the echocardiography laboratory. AVAI values >0.85 cm 2 /m 2, 0.6–0.85 cm 2 /m 2, and <0.6 cm 2 /m 2 were defined as no or mild AS, moderate AS, and severe AS, respectively. Results: Seventeen (24%) patients had moderate or severe AS. Visual AS scores assessed by emergency physicians and by expert sonographers showed excellent agreement (κ = 0.93), and a strong association was noted between the visual AS score assessed by emergency physicians and the AVAI assessed by expert sonographers ( R = –0.71, p < 0.0001). A visual AS score ≥3 assessed by emergency physicians had a sensitivity of 82%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 95% for diagnosing moderate or severe AS. The prevalence of new-onset AS-related events during hospitalization was higher in patients with visual AS score ≥3 assessed by emergency physicians than in the remaining patients [7 (50%) vs. 2 (3%), p < 0.0001]. Conclusion: The visual AS score is a useful AS screening tool for emergency physicians who are not expert cardiologists.