Doppler‐Detected Valve Movement in Aortic Stenosis: A Predictor of Adverse Outcome

Abstract Background The absence of auscultatory aortic valve closure sound is associated with severe aortic stenosis. The absence of Doppler‐derived aortic opening (A op ) or closing (A cl ) may be a sign of advanced severe aortic stenosis. Hypothesis Absent Doppler‐detected A op or A cl transient is indicative of very severe aortic stenosis and is associated with adverse outcome. Methods A total of 118 consecutive patients with moderate (n = 63) or severe aortic stenosis (n = 55) were included. A op and A cl signals were identified in a blinded fashion by continuous‐wave Doppler. Patients with and without A op and A cl were compared using χ 2 test for dichotomous variables and analysis of variance for continuous variables. The associations of A op and A cl with aortic valve replacement were determined. Results A op or A cl were absent in 22 of 118 patients. The absence of A op or A cl was associated with echocardiographic parameters of severe aortic stenosis. The absence of A op or A cl was associated with incident aortic valve replacement (36.4% vs 7.3%, respectively, P < 0.001). Even in patients with aortic valve area <1 cm 2 , the absence of A op or A cl was still associated with increased rate of aortic valve replacement (42.1% vs 13.9%, respectively, P = 0.019) and provided incremental predictive value over peak velocity. Conclusions In a typical population of patients with aortic stenosis, approximately 1 in 6 has no detectible aortic valve opening or closing Doppler signal. The absence of an A op or A cl signal is a highly specific sign of severe aortic stenosis and is associated with incident aortic valve replacement.