American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the recommended echocardiography frequency for asymptomatic aortic stenosis with a transvalvular velocity of 2-2.9 m/s?

1. q1-2y

2. q3-5y

3. q0.5-1y

4. Annual assessment

The correct answer is: q3-5y

For patients with asymptomatic aortic stenosis and a transvalvular velocity of 2-2.9 m/s, a frequency of echocardiography every 3 to 5 years is recommended. This guideline is based on the understanding that patients in this category generally have a slower progression of their condition, and monitoring at this interval allows for sufficient assessment of changes in severity without unnecessary intervention. The transvalvular velocity is a crucial measurement in determining the severity of aortic stenosis. In this range, the stenosis is often considered mild to moderate, and patients are not experiencing symptoms, which means they are less likely to require immediate surgical intervention. Regular follow-up with echocardiography helps to monitor for any changes in the hemodynamics or the development of new symptoms that would necessitate more frequent evaluation or an intervention. Monitoring every 1-2 years or annually would be more appropriate for patients with higher velocities (indicating more severe aortic stenosis) or those who are symptomatic, where more frequent evaluations are needed to manage the condition actively. Therefore, adhering to the 3-5 year recommendation provides a balance between monitoring progression and avoiding excessive testing in asymptomatic individuals.