Critical analysis of clinical factors in estimating severity of aortic valve disease

Clinical data were analyzed in a group of 79 patients with aortic stenosis or combined aortic stenosis and insufficiency by the usual methods and by discriminant function analysis. It was possible to predict the level of aortic-left ventricular gradient (above or below 50 mm Hg) from signs and symptoms in approximately 83 percent of patients. The analyses performed yielded insight into the significance of the various commonly presenting symptoms in these lesions. For example, the slope of the carotid upstroke, calcium in the valve, T wave inversion and a large thrusting left ventricular impulse all indicated a high peak gradient, whereas syncope did not contribute to the separation of values. Heart failure made an insignificant contribution to prediction of the level of gradient.