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We thank Dr. Heidenreich for his interest in our Editorial Comment (1) and respond to his query about cost effectiveness. I agree that we should have tested the cost effectiveness of quantitative assessment of coronary stenoses and of accurate measures of contractility long ago, and we did not. We still continue to use 40-year-old techniques to manage coronary disease, and one can only wonder how many needless stents were placed or how many significant lesions were missed that could have been treated more effectively with the use of better tools of assessment. That was the whole point of the editorial. Now we have the chance to apply quantitative techniques to valve disease. It would not seem to take many cases of aortic insufficiency poorly managed because of lesion misevaluation and the cost to society of those mistakes to prove cost effectiveness.
As with all cardiac evaluations, many lesions are so severe or so trivial as not to require quantification. It is the lesions in the middle where 2 to 3+ aortic regurgitation will never be good enough for me or for my patients.
- American College of Cardiology Foundation