Feasibility and relevance of right parasternal view for assessing severity and rate of progression of aortic valve stenosis in primary care

Background: Right parasternal view (RPV) is important in assessing the severity of aortic stenosis (AS). However, the feasibility and relevance of RPV in primary care is unresolved. Moreover, information regarding the role of RPV in the evaluation of the hemodynamic progression of AS is lacking. Methods: Consecutive patients with peak aortic valve velocity (V-max) >= 2.5 m/s were prospectively enrolled in a primary care echocardiographic laboratory. Aortic Doppler parameters were evaluated from apical view and RPV. Results: The total number of enrolled patients was 330 (aged 81 +/- 11 years, 47% female, left ventricular ejection fraction 64 +/- 9%). The RPV was feasible in 275 (83%). V-max and Mean Gradient were significantly higher and aortic valve area was significantly lower from RPV as compared to apical view (p < 0.0001 for all). Reclassification of severity towards either moderate or severe AS occurred in 13-26% of patients, according to different criteria, when evaluated from RPV. Among 108 patients (40%) undergoing multiple examinations the rate of progression was lower from the apical approach than from the RPV (0.19 +/- 0.20 m/s/year vs. 0.24 +/- 0.27 m/s/year, respectively; p = 0.03), and was fast (>0.3 m/s/year) in 17 patients (16%) from the apical window vs. 26 patients (24%) from RPV (p < 0.0001). Conclusion: Implementing RPV is feasible in primary care and results in a substantial reclassification rate through the entire spectrum of AS severity. Our data also suggest a potential role of Doppler interrogation from multiple windows to improve AS progression assessment. (C) 2017 Elsevier B.V. All rights reserved.