American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommendation for echocardiography frequency if the mean gradient is 40 or above in asymptomatic aortic stenosis?

1. q0.5-1y

2. q1-2y

3. q3-5y

4. Every 6 months

The correct answer is: q0.5-1y

In cases of asymptomatic aortic stenosis with a mean gradient of 40 mmHg or above, regular echocardiography is recommended to monitor the progression of the disease. A mean gradient at this level indicates a significant pressure difference across the aortic valve, suggesting that the stenosis is more severe and may lead to symptomatic changes or complications in the near future. The guideline recommendations advocate for more frequent monitoring, specifically every 6 to 12 months, in patients with severe aortic stenosis (typically defined as a mean gradient of 40 mmHg or a valve area of less than 1.0 cm²). This frequency allows for timely intervention, as symptoms can develop unexpectedly and may indicate the need for surgical intervention, such as valve replacement. Regular echocardiograms help in assessing the hemodynamic significance of the stenosis and the overall left ventricular function, thus guiding clinical decision-making. In contrast, less frequent echocardiography, such as once every 1 to 2 years or 3 to 5 years, would not be adequate for a patient with such a high mean gradient, as significant clinical changes could occur within a shorter timeframe. Therefore, the recommendation for echocardiography every 0.5 to