American Board of Internal Medicine (ABIM) Certification Practice Exam

In asymptomatic aortic stenosis, what is the echocardiography frequency if the mean gradient is less than 20?

1. q0.5-1y

2. q1-2y

3. q3-5y

4. q6-12m

The correct answer is: q3-5y

In patients with asymptomatic aortic stenosis where the mean gradient is less than 20 mmHg, a less frequent echocardiographic follow-up is appropriate. The recommendation for monitoring in this scenario is typically to perform echocardiography every 3 to 5 years. This approach is based on the understanding that patients with mild aortic stenosis and low gradients are at lower risk for rapid disease progression. When gradients are less than 20 mmHg, it indicates that the stenosis is not severe enough to warrant closer monitoring frequently for significant changes. As a result, the echocardiography frequency of every 3 to 5 years allows for appropriate surveillance while reducing unnecessary tests, aligning with clinical guidelines that prioritize both patient safety and resource utilization. In contrast, more frequent evaluations (like annual checks or semi-annual checks) are reserved for those with greater severity in aortic stenosis, major symptoms, or higher mean gradients. The management strategy emphasizes the need for individualized treatment, yet in asymptomatic patients with lesser severity, a conservative and spaced monitoring plan is warranted.