American Board of Internal Medicine (ABIM) Certification Practice Exam

How often should echocardiography be performed if the mean gradient for asymptomatic aortic stenosis is between 20-39?

1. q0.5-1y

2. q3-5y

3. q1-2y

4. Every 6 months

The correct answer is: q1-2y

For patients with asymptomatic aortic stenosis who have a mean gradient between 20-39 mmHg, echocardiography should be performed every 1 to 2 years. This recommendation stems from the understanding that in this range, patients may have significant progression in their condition, even if they are asymptomatic. Regular monitoring allows for timely intervention should clinical symptoms develop or should there be significant changes in the echocardiographic parameters, including worsening gradients or decreasing valve area. Regular echocardiography at this interval helps to ensure patient safety by providing adequate surveillance and enabling management decisions to be made based on any changes observed. It is crucial to monitor these patients closely to avoid unexpected complications given the potential for rapid progression of the disease. The other suggested intervals either do not allow for adequate monitoring of disease progression or are more appropriate for patients with milder forms of stenosis or with less significant gradients.