Table 2.

Standard TTE images for the assessment of AS.

View (modality)	Measurement	Explanatory notes	Image
Parasternal long axis (PLAX); 2D	LV dimensions Calculate indexed LV mass using linear method	Visual assessment of wall motion Calcification of aortic valve (see ‘Calcification and aetiology of AS’ section) Indexed LV mass is a prognostic marker in AS (see ‘Additional prognostic markers’ section)
Parasternal long axis; zoom 2D		Assess calcification and mobility of cusps Advanced AS unlikely without significant cusp calcification or restriction Assess for central vs eccentric closure line suggesting BAV (‘Anatomy’ section)
Parasternal long axis; zoom 2D with colour Doppler		Assess for turbulence and presence of aortic regurgitation
Parasternal long axis; zoom 2D	LVOT dimension for assessment of AVA and stroke volume	Obtained at level of cusp insertion Inner-edge to inner-edge in mid-systole when LVOT is at a maximum Measurement parallel to aortic valve See ‘Essential parameters in the echocardiographic assessment of AS severity’ section
Parasternal long axis; zoom 2D	Measurement of the aorta including the sino-tubular junction	Inner-edge to inner-edge method in end-diastole May be used in the assessment of the energy loss index (ELI; see ‘Additional parameters in the assessment of aortic valve stenosis’ section)
Parasternal short axis (PSAX); 2D		Overview Visual appearance of aortic valve – cusp calcification and mobility
Parasternal short axis; zoom 2D (+ colour Doppler)		Morphology of valve Visual appearance of calcification and mobility of cusps Colour Doppler to assess for presence and origin of AR
Apical 4-chamber view; 2D imaging optimized for LV assessment	LV volumes and LVEF using quantitative methodology Consider GLS	LVEF is a prognostic marker in AS (see ‘Additional prognostic markers’ section) GLS is a potential marker of prognosis in AS (see ‘Additional prognostic markers’ section)
Apical 5-chamber view; 2D imaging (+ colour Doppler)		Overview Visual appearance of aortic valve – cusp calcification and mobility Colour Doppler assessment for AR
Apical 5-chamber view; 2D imaging zoom	CW Doppler tracings for AV Vmax and mean AVG	Sweep speed 50–100 mm/s Trace around dense aspect of Doppler curve Average of three tracings in sinus rhythm (SR) See ‘Essential parameters in the echocardiographic assessment of AS severity’ section for optimization and troubleshooting
Apical 5-chamber view; 2D imaging zoom	PW Doppler tracing in LVOT for calculation of stroke volume and AVA	Sweep speed 50–100 mm/s Trace around modal velocity Average three tracings in SR See ‘Essential parameters in the echocardiographic assessment of AS severity’ section for optimization and troubleshooting
Apical 2-chamber view; 2D imaging focus on LV	LV volumes and LVEF using quantitative methodology Consider assessment of GLS	LVEF is a prognostic marker in AS (see ‘Additional prognostic markers’ section) GLS is a potential marker of prognosis in AS (see ‘Additional prognostic markers’ section)
Apical 3-chamber window; 2D imaging (+ colour Doppler)		Overview Calcification and mobility of aortic valve + colour Doppler for assessment of AR Consider GLS (see ‘Additional prognostic markers’ section)
Apical 3-chamber view; 2D imaging zoom AV + repeat CW and PW Doppler		Mobility and calcification of valve Repeat Doppler tracings for assessment of severity
Suprasternal notch; 2D + colour Doppler	Aortic arch	Look for turbulence and aortic pathology Repeat CW Doppler for AV Vmax and mean AVG (see ‘Essential parameters in the echocardiographic assessment of AS severity’ section)
Suprasternal notch; 2D + colour Doppler		Distal arch/descending aorta; look for turbulence and pathology including coarctation
PEDOF or standalone imaging Try all imaging windows including right parasternal (shown)	AV Vmax and mean gradient	Repeat from all imaging windows to ensure maximal values of Vmax and mean gradient are obtained