[en] Purpose. Primary objective: to determinate the value of non-apical views (right parasternal; RPV, subcostal; SCV and suprasternal notch; SSNV) in the up-grading of patients with aortic stenosis (AS) initially evaluated from apical 5 chamber view (A5CV). Secondary objectives: a) to investigate the feasibility and reproducibility of non-apical views AS appraisal, b) to assess the prognostic relevance of the aforementioned reclassification. Methods. We designed an observational study that included 269 patients (mean age 76±9 years, 44% females) with AS recruited prospectively in whom the stenosis was graded by echocardiography from A5CV and non-apical view. Follow-up was performed by review of medical records and telephone interviews when considered necessary. Results. Feasibility AS assessment from RPV, SCV and SSNV was 78%, 81% and 56%, respectively (SCV vs SSNV, p=0.009). AS were up-graded from non-apical views according to maximal velocity, mean gradient, area and indexed area by 24%, 17%, 24% and 22%, respectively (p<0.0001). Non-apical views reclassified from non-severe to severe AS, from low gradient severe to high gradient severe AS and from non-critical to critical AS 19%, 23% and 3% of cases (p<0.0001). The 4-years hard cardiac events rate was 41% in patients with non-severe AS, 67% in patients with severe AS from non-apical views, 68% in patients with severe AS from A5CV and 80% in patients with severe AS from A5CV and non-apical views (p<0.001). Reproducibility of AS evaluation from non-apical views was fair to excellent (intraclass correlation coefficients: SSNV=0.44, RPV=0.61, SCV=0.92). Conclusion. Assessment of AS from non-apical views is feasible, reproducible and valuable over A5CV so its use is encouraged.

[gl] Propósito. Obxectivo principal: determinar o valor dos planos ecocardiográficos non apicais (PNA; parasternal dereito (PED), subcostal (SC) e suprasternal (SE) na reclasificación ascendente da estenose aórtica (EA) graduada a partir do plano apical 5 cámaras (API5c). Obxectivos secundarios: a) analizar a factibilidade e reproducibilidade da gradación da EA mediante PNA, b) avaliar a relevancia prognóstica da reclasificación ascendente da EA a través dos PNA. Métodos. Recrutáronse prospectivamente 269 doentes con EA (idade media 76±9 anos, 44% mulleres) ós que se someteu a unha valoración ecocardiográfica da estenose dende os planos API5c e PNA. Despois do ecocardiograma os doentes foron seguidos a través da revisión das historia clínicas electrónicas e mediante entrevistas telefónicas cando se considerou necesario. Resultados. A factibilidade da gradación da EA dende PNA foi a seguinte: PED 78%, SC 81% e SE 56% (SC vs SE, p=0,009). As reclasificación ascendentes polos PNA de acordo a criterios de velocidade máxima, gradiente medio, área y área indexada foron do 24%, 17%, 24% e 22% respectivamente (p<0,0001). De acordo os criterios de gravidade observáronse as seguintes reclasificacións co estudo mediante os PNA: de EA non grave a EA grave 19%, de EA grave de baixo gradiente a EA grave de alto gradiente 23% e de EA non crítica AE crítica 3% (p<0,0001). As taxas de eventos cardíacos maiores observadas ós 4 anos de seguimento foron: nas EA non graves 41%, nas EA graves nos PNA 67%, nas EA graves no plano API5c 68% e nas EA graves nos planos API5c e PNA 80% (p<0,001). A reproducibilidade da cuantificación da EA dende os PNA foi de aceptable a excelente (coeficientes de correlación intraclase: PED=0,61, SC=0,92, SE=0,44) Conclusión. A avaliación da EA dende os PNA é factible, reproducible e proporciona un valor adicional ó estudo desde API5c polo que se recomenda o seu uso.