Echo readings

I am on the annual echo cycle since I had my mitral valve replaced. So far the mitral is fine.

However they found a bicuspid aortic valve with fused right and left coronary cusps and fibrocalcific changes with reduced opening (stenosis).

The drama for me has been the changes in the Aortic Valve readings:

Year / AVA (Vmax) cm2 / AVA Index
2013 / 2.5 VTI / 1.1
2019 / 1.3 / 0.7
2020 / 1.3 / 0.8
2021 / 1.7 / 0.8
2022 / 2.0 / 0.9

The only change that has happened in the last 2 years is my being serious about controlling my cholesterol. I was in high averaging 250mg/dL; LDL 180 but last November I was down to 115mg/dL; LDL 41(Lipitor/Niacin and Red Yeast Rice...I added the last 2).

These numbers are going in the opposite direction. Anyone seen a trend like this? I will see my cardio in December for our biannual chat buy questions are:
Is this a real trend? Maybe related to reduced arteriosclerosis?
Errors in measurements. I know for sure doctors review old reports so there may be a bias to be consistent somewhat.

All echos done at the same hospital but different staff.

I’d be interested to hear what your cardio says. My valve area readings on annual echos have fluctuated up and down but not that much. Couple of times they’ve ordered a TEE to get greater accuracy.

Heart readings can improve over time, even in cases of calcium build-up, etc. Lifestyle, supplements, qigong, etc. can sometimes reverse downward trends. Rapamycin - a popular anti-aging drug - is known to repair atherosclerosis.

My mother had severe anemia when she had a heart echo done the other year. Although they said she had very mild aortic stenosis (wasn't even going to tell us, but I happened to read the test results). They weren't even sure she had it because severe anemia can easily give false readings. I believe they said they would have to retest and most likely do a TEE to really make sure.

Things appear to be really looking up for you, friend. Congratulations!

Please take care and keep getting better and better and better.

I spoke to the cardio and he says there is a correlation between arteriosclerosis and valve calcification and though not perfectly correlated there studies suggest a relation. Controlling cholesterol and CAD has benefits to heart valves but he however cautioned that this will delay the inevitable and that is a good thing but not a cure.

Possible reasons for the valve area to inaccurate (it doesn’t make sense that the valve area would increase with time)
1) valve area error due to mitral valve interference before it was fixed
2) valve area involves making a measurement that has error and then squaring it - so any error is squared
3) Is there aortic regurgitation as well? This could also contribute to error.
4) the peak aortic velocity is the probably the most reliable measurement. See what the trend is for that.

None of those measurements seem worrying at this stage. Good luck with your future measurements.

Mister_James said:

I am on the annual echo cycle since I had my mitral valve replaced. So far the mitral is fine.

However they found a bicuspid aortic valve with fused right and left coronary cusps and fibrocalcific changes with reduced opening (stenosis).

The drama for me has been the changes in the Aortic Valve readings:

Year / AVA (Vmax) cm2 / AVA Index
2013 / 2.5 VTI / 1.1
2019 / 1.3 / 0.7
2020 / 1.3 / 0.8
2021 / 1.7 / 0.8
2022 / 2.0 / 0.

Click to expand...

20

Mister_James said:

The only change that has happened in the last 2 years is my being serious about controlling my cholesterol. I was in high averaging 250mg/dL; LDL 180 but last November I was down to 115mg/dL; LDL 41(Lipitor/Niacin and Red Yeast Rice...I added the last 2).

These numbers are going in the opposite direction. Anyone seen a trend like this? I will see my cardio in December for our biannual chat buy questions are:
Is this a real trend? Maybe related to reduced arteriosclerosis?
Errors in measurements. I know for sure doctors review old reports so there may be a bias to be consistent somewhat.

All echos done at the same hospital but different staff.

Click to expand...

Mister_James said:

I am on the annual echo cycle since I had my mitral valve replaced. So far the mitral is fine.

However they found a bicuspid aortic valve with fused right and left coronary cusps and fibrocalcific changes with reduced opening (stenosis).

The drama for me has been the changes in the Aortic Valve readings:

Year / AVA (Vmax) cm2 / AVA Index
2013 / 2.5 VTI / 1.1
2019 / 1.3 / 0.7
2020 / 1.3 / 0.8
2021 / 1.7 / 0.8
2022 / 2.0 / 0.9

Click to expand...

Year / AVA (Vmax) cm2 / AVA Index
2013 / 2.5 VTI / 1.1
2019 / 1.3 / 0.7
2020 / 1.3 / 0.8
2021 / 1.7 / 0.8
2022 / 2.0 / 0.9
2023 MRI no echo
2024/1.9/0.86

and commentary is now still bicuspid aortic valve...there are fibrocalcific changes with mildly reduced opening.

That is some significant difference in valve area. The continuity equation is used in calculating valve area, which means that one of the measurements is squared in the calculation, which Astro touched on. This is one of the reasons why there are typically 3 or 4 metrics used to determine the severity of aortic stenosis. The most common three are valve area, peak jet velocity and mean pressure gradient. Many hospitals now also include a metric called the dimensionless index, which tends to be very accurate.
Personally, valve area had some significant variance early on for me; going from 1.0cm2 to 1.4cm2. If I didn't know better I would have thought that my valve opening was getting larger. But, the other metrics were discordant from valve area in that echo- my stenosis was, in fact, progressing and not getting better.

So, it would be interesting to know if your other metrics agree with the AVA on these echos.

Hopefully, your two most recent echos are the most accurate. AVA of 1.9cm2 or 2.0cm2 is a long way from the danger zone. Hoping your other metrics agree with the big AVA measurements and not the small ones.

Indeed, one cannot but agree with the idea of the necessity to think beyond the single figure in the context of aortic stenosis. These small differences are problematic, especially when it comes to the continuity equation and can cause a huge variance in calculated value of valve area. The good thing is that you know that there are disparities and are ready to look at the general picture. The other parameters, peak jet velocity, and mean pressure gradient are closer to the larger AVA measurements or the smaller ones?