Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease (original) (raw)
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The American Journal of Cardiology, 1991
Doppler echocardiography has been widely used as a noninvasive method to quantify valvular heart diseases. This study assessed the variability between 2 echocardiography centers concerning P-dimensional and Doppler echocardiographic results in the quantification of mitral and aortic valve stenoses. Forty-two patients were studied by 2 different echocardiography centers in a blinded, independent fashion. In patients with aortic and mitral valve stenosis, mean and maximal flow velocities were measured. The aortic valve orifke area was calculated according to the continuity equation. Mitral valve orifice area was determined by direct planimetry and by pressure half-time. In patients with an aortic valve stenosis, a close relation between the 2 centers was found for the maximal and mean flow velocities (coefficient of correlation, r = 0.72 to 0.92; coefficient of variation, 3.7 to 7.7%). A close correlation and a small observer variability was found for the flow velocity ratio determined by flow velocities measured in the left ventrkular outflow tract and over the stenotic valve (r = 0.88, coefficient of variation, 0.01 f 0.00s). In contrast, there was a poor correlation between the diameter of the left ventricular outflow tract and the aortic orifice area (r = 0.36 and 0.59, respectively). In patients with a mitral valve stenosis, mean and maximal velocities were closely correlated (r = 0.66 and 0.77, respectlvely). Velocities were not found to be significantly different between the 2 centers. Vari-From the Universit8tsklinik Freiburg, Junere Medizin III, Federal Republic of Germany, and Rehabilitationszentrm Bad Krozingen, Federal Republic of Germany.
The assessment of mitral valve disease: a guideline from the British Society of Echocardiography
Echo Research and Practice
Mitral valve disease is common. Mitral regurgitation is the second most frequent indication for valve surgery in Europe and despite the decline of rheumatic fever in Western societies, mitral stenosis of any aetiology is a regular finding in all echo departments. Mitral valve disease is, therefore, one of the most common pathologies encountered by echocardiographers, as both a primary indication for echocardiography and a secondary finding when investigating other cardiovascular disease processes. Transthoracic, transoesophageal and exercise stress echocardiography play a crucial role in the assessment of mitral valve disease and are essential to identifying the aetiology, mechanism and severity of disease, and for helping to determine the appropriate timing and method of intervention. This guideline from the British Society of Echocardiography (BSE) describes the assessment of mitral regurgitation and mitral stenosis, and replaces previous BSE guidelines that describe the echocardi...
Practical echocardiography in aortic valve stenosis
Journal of Cardiovascular Medicine, 2008
on behalf of the Working Group on Echocardiography of the Italian Society of Cardiology Aortic valve stenosis is a common disease. Despite this, the diagnosis may often be missed; a significant proportion of patients are still identified at post-mortem examination, and 5% of operations are performed at end stage. Unrecognized aortic valve stenosis is an important cause of anesthetic mortality. One reason for failing to make a diagnosis is that the clinical signs can be difficult to interpret due to the confounding association with arterial hypertension, coronary artery disease and systemic arteriosclerosis, potentially blunting the effects of aortic valve stenosis on the circulation. Moreover, most patients with aortic valve stenosis have a long asymptomatic period and may not seek medical attention. In patients with severe, symptomatic, calcific aortic valve stenosis, aortic valve replacement is the only effective treatment; much evidence suggests that it should be offered to patients regardless of age, after appropriate clinical evaluation. Doppler echocardiography plays a pivotal role in confirming the diagnosis of aortic valve stenosis in assessing the severity of the disease and, ultimately, in giving prognostically relevant information. Moreover, echocardiography is suitable for monitoring of disease progression and left ventricular function in these patients, and is of fundamental support for clinical follow-up. Accurate noninvasive quantification of aortic valve stenosis is, however, a technically demanding and time-consuming procedure, with several potential pitfalls. Considering the frequency and importance of aortic valve stenosis, a comprehensive echocardiographic study should be offered and carefully performed in all patients with noteworthy murmurs and repeated regularly (at appropriate time intervals), together with clinical review, in patients in whom aortic valve stenosis has been diagnosed.
Heart, 1987
Transmitral pressure half time (PHT) was assessed by continuous wave Doppler in 44 patients with rheumatic mitral valve stenosis (14, pure mitral valve stenosis; 15, combined mitral stenosis and regurgitation; and 15 with associated aortic valve regurgitation). The mitral valve area, derived from transmitral pressure half time by the formula 220/pressure half time, was compared with that estimated by cross sectional echocardiograpy. The transmitral pressure half time correlated well with the mitral valve area estimated by cross sectional echocardiography. The correlation between pressure half time and the cross sectional echocardiographic mitral valve area was also good for patients with pure mitral stenosis and for those with associated mitral or aortic regurgitation. The regression coefficients in the three groups of patients were significantly different. Nevertheless, a transmitral pressure half time of 175 ms correctly identified 20 of 21 patients with cross sectional echocardiographic mitral valve areas < 1-5 cm2. There were no false positives. The Doppler formula significantly underestimated the mitral valve area determined by cross sectional echocardiography by 28 (9)% in 19 patients with an echocardiographic area >2 cm and by 14 8 (8)% in 25 patients with area of < 2 cm2. In thirteen patients with pure mitral
Journal of The American College of Cardiology, 1988
Noninvasive evaluation of aortic stenosis lacked quantilalive hemrdynamic informalion before the application of Doppler echocardiography. In 15 ¶080. Hatlc et al. (II repwted that the pressure @-adient across a stenotic aortic valve could be estimated from oeak Doorder sonic Row velocitv with use of the modified Bemoiii equafion. Subsequent validation studies 12-6) demonstrated an excellent towel.+ don between pressure gradients by Doppler and by cardiac catbelerization. Peak Doppler Row velocity or prewre gradient alone. houever. is not always sufficient to determine the severity Gf aortic stenosis. because Row vrlocily and pressure gradient vary with car&w output lor a siren sonic valve area. Recently. several studier 17-10) examining small numbers of patients have shown that sonic wdvc area cuuid be ~eiirbly &naled from two-dimensioeel sad Doppkr echwudiography with we of the continuity equalion. We performed a prospective otudy 10 compare Dopplerderived aoilic valve area with cnlheterilation-derived sonic valve area in a large group of patimts with amtic stenosis. We also sought to deiermise oihtr Doppler variables that might be useful in predicting the rsverity of antic slmo~is. S~wdy p&kale. ia+dimensional and Doppler u.hocardioemnh) was performed in I20 palientr undergoing clinically b&ted ~cardrx catheterizauun for aortic slcnosis from July 1981 to September 1986. Twelve patients had aasociatcd wsreaonic regqiiladon and were excluded from funher analysis because of Ihe limitation of cardiac catheter-i&on in determining aoctic valve area in this wp.
Determination of the stenotic aortic valve area in adults using Doppler echocardiography
Journal of the American College of Cardiology, 1986
The severity of aortic stenosis was evaluated by Doppler echocardiography in 48 adults (mean age 67 years) undergoing cardiac catheterization. Maximal Doppler systolic gradient correlated with peak to peak pressure gradient (r = 0.79, y = 0.63x + 25.2 mm Hg) and mean Doppler gradient correlated with mean pressure gradient (r = 0.77, Y = 0.5,}x + 1".0 mm Hg) by manometry. The transvalvular pressure gradient is flow dependent, however, and associated left ventricular dys• function was common in our patients (33%). Thus, of the 32 patients with an aortic valve area less tball or equal'to 1.0 cm 2 at catheterization, 6 (19%) had a peak Doppler gradient less than 50 mm Hg.
International Journal of Cardiology, 1981
During a ll-mth period 162 consecutive patients with mitral stenosis underwent examination by M-mode as well as cross-sectional echocardiography. The mitral valve area was measured by cross-sectional echocardiography and the severity of mitral stenosis by M-mode echocardiography. Out of the total, 69 patients underwent left and right heart catheterization and in 53 of these the mitral valve area was calculated. A correlation 'of r = 0.92 for the mitral valve area was found between sector scan echocardiography and cardiac catheterization, whereas the correlation between Mmode echocardiography and catheterization yielded a result of only r = 0.38. Thus the assessment of the severity of mitral stenosis by cross-sectional echocardiography is a reliable alternative to cardiac catheterization. mitral stenosis; echocardiography; correlation between cardiac catheterization and echocardiography