Over the last two decades, the differentiation of severe from non-severe aortic valve stenosis with echocardiography has become more complex. The consideration of flow is now frequently essential to evaluate haemodynamic stenosis severity. Low flow can result in low gradient and, thereby, mask severe aortic stenosis. On the other hand, low flow may impede complete opening of the valve and result in overestimation of the severity by aortic valve area (AVA). Since echocardiographic assessment of flow incorporates parameters which are also used to quantify gradient and AVA, measurement errors may lead to major misclassifications of the disease. This has stimulated the search for a method evaluating stenosis severity by morphological criteria independent of haemodynamics. European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for the management of valvular heart disease 2021 recommend quantification of valve calcification by CT for assessing the severity of aortic stenosis in patients with low gradient. Aortic valve calcification is measured in (arbitrary) Agatston units (AU), and the diagnosis of severe aortic stenosis considered likely with values >2000 in men and >1200 in women. In the two main studies in this field,1 2 areas under the curve (AUCs) from receiver operating characteristic (ROC) for the diagnosis of severe aortic stenosis compared with echocardiography were …

中文翻译：

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对主动脉瓣狭窄严重程度进行性别特异性和形态特异性评估

在过去的二十年中，超声心动图区分严重和非严重主动脉瓣狭窄变得更加复杂。现在，考虑血流对于评估血流动力学狭窄的严重程度通常至关重要。低流量可导致低梯度，从而掩盖严重的主动脉瓣狭窄。另一方面，低流量可能会阻碍瓣膜完全打开，并导致主动脉瓣面积 (AVA) 高估严重程度。由于血流超声心动图评估包含也用于量化梯度和 AVA 的参数，因此测量误差可能会导致疾病的严重错误分类。这刺激了人们寻找一种通过独立于血流动力学的形态学标准来评估狭窄严重程度的方法。欧洲心脏病学会/欧洲心胸外科协会 2021 年瓣膜性心脏病治疗指南建议通过 CT 量化瓣膜钙化，以评估低梯度患者主动脉瓣狭窄的严重程度。主动脉瓣钙化以（任意）Agatston 单位 (AU) 为单位进行测量，男性值 >2000，女性值 >1200 时，很可能诊断为严重主动脉瓣狭窄。在该领域的两项主要研究中，1 与超声心动图相比，用于诊断严重主动脉瓣狭窄的受试者工作特征 (ROC) 的曲线下面积 (AUC) 为 2 个……