American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the significance of monitoring transvalvular velocity in asymptomatic aortic stenosis?

1. To determine surgical timing only

2. To assess risk of progression

3. To estimate ejection fraction

4. To evaluate ventricular hypertrophy

The correct answer is: To assess risk of progression

Monitoring transvalvular velocity in asymptomatic aortic stenosis is significant because it helps assess the risk of disease progression. In patients with aortic stenosis, the transvalvular gradient can indicate the severity of the stenosis. As the condition advances, the velocity of blood flow through the narrowed valve increases. This increase in velocity is associated not only with the severity of the stenosis but also with the likelihood of developing symptoms and potential adverse outcomes. Thus, by measuring transvalvular velocity over time, clinicians can identify patients at higher risk for progression to symptomatic aortic stenosis, which may necessitate surgical intervention. This monitoring assists in making timely decisions regarding the management of the condition, ensuring that intervention occurs before the onset of symptoms such as syncope, heart failure, or sudden cardiac death, which are often associated with severe aortic stenosis. Other aspects such as surgical timing, estimation of ejection fraction, and evaluation of ventricular hypertrophy, while relevant to the overall management of aortic stenosis, do not directly relate to the primary role of transvalvular velocity monitoring in assessing disease progression. The focus on risk assessment for progression is crucial in asymptomatic patients, as it helps guide follow-up strategies and potential interventions