Aortic stenosis guideline published

The British Society of Echocardiography (BSE) is delighted to announce the publication of a new aortic stenosis guideline, updating previous guidance to reflect contemporary practice.

The new guideline comprehensively covers all aspects of the echocardiographic assessment of aortic stenosis. This includes important background information such as aortic valve anatomy, the aetiology of aortic stenosis, and a description of the haemodynamics of AS. As with all BSE guidance, there is a practical-based approach with tables describing the images that should be obtained during an echocardiographic study, and detailed descriptions of how the assessment of AS severity should be undertaken. 

The guidance also provides a practical approach when faced with challenging scenarios in aortic stenosis. For example, in patients with impaired LV systolic function, or patients with apparently severe AS but with low Doppler gradients. 

Finally, the guidance also talks through common situations including mixed aortic valve disease and the assessment of AS when patients co-present with additional valve disease.

This guideline is considerably more comprehensive than the existing version. Many of the areas touched upon by this guideline (for example: anatomy and haemodynamic considerations of AS) are new inclusions for this guideline. 

The fundamentally important message from this guideline is that the assessment of AS should be based around obtaining accurate Doppler indices, with a particular focus on using the PEDOF probe from multiple echocardiographic windows. In addition, there are one or two important new messages, for example the method of measuring the LVOT diameter when calculating the aortic valve area.

Most of the guideline is very similar to existing European or American guidance, albeit with a more practical based approach. This is not a ‘clinical guideline’ and as such does not make recommendations as to when a patient requires intervention. Our approach is focused around the practicalities of obtaining the best information from echocardiography, and highlighting important prognostic findings that may help guide clinical decision-making.

Lead author Dr Liam Ring, Consultant Cardiologist at West Suffolk NHS Foundation Trust said "I hope that this new guideline will support sonographers, physiologists and healthcare scientists in the assessment of AS using echocardiography, which will translate into improved care for our patients."

Read the guideline