Simple echocardiographic scoring in screening aortic stenosis with focused cardiac ultrasonography in the emergency department

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. Emer-gency 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 (kappa = 0.93), and a strong association was noted between the visual AS score assessed by emergency physicians and the AVAI assessed by ex-pert sonographers (R = -0.71, p < 0.0 0 01). 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 hospi-talization 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. (C) 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Automated summary

The study evaluated the diagnostic accuracy of a visual AS score developed by emergency physicians for screening AS. The results showed that a visual AS score >3 had high sensitivity, specificity, and predictive value for diagnosing moderate or severe AS, and patients with a score >3 had a higher prevalence of AS-related events during hospitalization.