{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T18:44:36Z","timestamp":1788893076600,"version":"build-2803163510"},"reference-count":16,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,11,25]],"date-time":"2019-11-25T00:00:00Z","timestamp":1574640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This study was performed to evaluate an additional echocardiographic spectral Doppler marker, which would identify severe aortic stenosis (AS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Echocardiography is most commonly utilized to assess AS and has been validated against invasive measurements. However, the data obtained are not always in agreement, leaving a conundrum regarding the true severity of AS and can lead to other diagnostic procedures. This highlights the importance of improved noninvasive diagnostic techniques.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Forty\u2010eight indeterminate cases of calcific AS that had been previously evaluated by both echocardiography and cardiac catheterization were included in the study, using cardiac catheterization as the gold standard for calculation of aortic valve area (AVA). The intensity of opening and closing of the aortic valve, represented by bright vertical deflections on the CW spectral waveform, was quantified using ImageJ software to generate pixel intensity histograms to create opening and closing click (OC and CC) ratios. These ratios were compared with echocardiographic variables and catheterization AVA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010five patients were found to have severe AS and 13 patients were found to have nonsevere AS, as assessed by cardiac catheterization. CC ratio was found to be a significant predictor of severe AS with an OR 0.024 (95% CI: 0.002\u20100.378, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.0079). Adding CC to a model using standard echocardiographic parameters resulted in significant improvement in the C\u2010statistic (0.693 to 0.835, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.0134).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An additional Doppler marker measuring the aortic valve CC ratio has been found to improve detection of severe AS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.14541","type":"journal-article","created":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T06:07:44Z","timestamp":1574748464000},"page":"2158-2166","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Quantitative analysis of spectral Doppler clicks in assessment of aortic stenosis"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6660-2635","authenticated-orcid":false,"given":"Brent","family":"White","sequence":"first","affiliation":[{"name":"University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Wessel","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weili","family":"Zheng","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Sovari","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sreenivas","family":"Konda","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Frazin","sequence":"additional","affiliation":[{"name":"University of Illinois at Chicago Chicago IL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,11,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0b013e3182213f23"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0b013e31805f6796"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.03.002"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.006767"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/hj.1999.v137.95496"},{"key":"e_1_2_7_7_1","first-page":"157","volume-title":"The heart","author":"Leatham A","year":"1985"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.62.5.372"},{"key":"e_1_2_7_9_1","first-page":"794","article-title":"Planimetric quantification of aortic valve stenosis using multiplanar transesophageal echocardiography","volume":"82","author":"Gysan D","year":"1993","journal-title":"Z Kardiol"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/echo.12675"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.07.2069"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2018-313003"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.26033"},{"key":"e_1_2_7_14_1","first-page":"B3","article-title":"Getting a click out of aortic stenosis: use of spectral Doppler clicks in continuous wave Doppler to identify severe aortic stenosis","volume":"25","author":"Amstel D","year":"2012","journal-title":"J. Am Soc Echo"},{"key":"e_1_2_7_15_1","first-page":"ei","article-title":",American College of Cardiology\/American Heart Association et al. 2014 AHA\/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"148","author":"Nishimura RA","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.06.051"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcct.2017.01.007"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.14541","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.14541","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.14541","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T11:51:59Z","timestamp":1694087519000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.14541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,25]]},"references-count":16,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1111\/echo.14541"],"URL":"https:\/\/doi.org\/10.1111\/echo.14541","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,25]]},"assertion":[{"value":"2019-08-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}