Accurate assessment of aootic stenosis severity by Doppler echocardiography independent of aortic jet velocity (original) (raw)
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Duration of ejection in aortic stenosis: Effect of stroke volume and pressure gradient
Journal of the American College of Cardiology, 1984
The theoretical effect of variable ventricular function on left ventricular ejection time in aortic stenosis was predicted by applying data measured in 52 patients with pure aortic stenosis to equations derived from the relations of Gorlin and Gorlin and Weissler et aI. Ejection time and aortic valve area are not, of necessity, linearly related because
Journal of the American Society of Echocardiography, 2017
Background: Inconsistencies between gradients and aortic valve area are frequent in the echocardiographic evaluation of aortic stenosis (AS). Assessing AS severity is essential for the correct management of the disease. The aim of this study was to evaluate whether ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET), could be diagnostic parameters in patients with AS. Methods: Patients with AS (aortic peak velocity > 2 m/sec) were prospectively enrolled. Quantitative echocardiographic Doppler parameters including ejection dynamics (AT, ET, and AT/ET ratio) as well as conventional and clinical parameters were analyzed. AT, ET, and AT/ET ratio were calculated in different stages of AS. A receiver operating characteristic curve was plotted to determine the best cutoff value to identify severe AS. Results: Two hundred sixty-two patients were included (mean age, 75 6 8 years; 54% women), of whom 109 (42%) had severe AS, 99 (38%) had moderate AS, 22 (8%) had mild AS, 24 (9%) had classical low-flow, low-gradient severe AS, and eight (3%) had paradoxical low-flow, low-gradient severe AS. AT was higher in patients with higher levels of severity of AS (65 6 16 vs 82 6 19 vs 109 6 23 msec, P < .001) as well as AT/ET ratios (0.22 6 0.05 vs 0.29 6 0.07 vs 0.37 6 0.06, P < .001). Using a cutoff of 94 msec, AT had sensitivity of 71% and specificity of 81% for severe AS; using a cutoff of 0.35, the AT/ET ratio had sensitivity of 59% and specificity of 86%. On multivariate analysis, AT was associated with effective orifice area (B = À0.64, P < .001) and ET with heart rate (B = À0.62, P < .001) and age (B = 0.30, P = .04).
Value of Left Ventricular Indexed Ejection Time to Characterize the Severity of Aortic Stenosis
Journal of Clinical Medicine, 2022
Aims: The assessment of aortic stenosis (AS) severity is still challenging, especially in abnormal hemodynamic conditions. Left ventricular ejection time (LVET) has been historically related to AS severity, but it also depends on heart rate (HR) and systolic function. Our aim was to verify if correcting LVET (LVET index, LVETI) by its determinants is helpful for the assessment of AS severity, irrespective of hemodynamic conditions. Methods and results: We retrospectively studied 152 patients with AS and 378 patients with heart failure and no-AS. At multivariate analysis, LVET (assessed with pulsed-wave Doppler) showed a strong correlation with stroke volume index (SVI) (Beta 0.354; p < 0.001), HR (−0.385; p < 0.001), AS grade (Beta 0.301; p < 0.001) and, less significantly, ejection fraction (LVEF) (Beta 0.108; p = 0.001). AS grade was confirmed to be a major determinant of LVET, irrespective of forward flow (assessed by SVI and transvalvular flow rate) and LVEF (above and ...
Journal of the American College of Cardiology, 1998
Objectives. Flow variations can affect valve-area calculation in aortic stenosis and lead to inaccuracies in the evaluation of the stenosis. Knowing that transvalvular flow varies normally within one beat, we designed this study to assess the response of the valve to intrabeat variation of flow during systole. Results were compared with flow-derived measurements. Background. Technological improvements now allow us to evaluate aortic valve area directly by short axis planimetry. This offers the possibility to perform serial planimetries during one ejection phase and analyze the intrabeat dynamic behavior of the stenotic-aortic valve and compare these measurements with flowderived measurements. Methods. Forty echocardiograms displaying different degrees of aortic stenosis were analyzed by frame-by-frame planimetry of the valve area from onset of opening to complete closure. Maximalmean area, opening and closing rates and ejection times were obtained and compared with Doppler-derived data. Results. Valve area varied during ejection. Stenotic valves opened and closed more slowly than normals and remained maximally open for a shorter period. Mean area by Doppler data corresponded more closely to maximal than to mean-planimetered area. Duration of flow was shorter than valve opening in severely stenotic valves. Discrepancies between Doppler-derived and twodimensional (2D) measurements decreased in less stenotic valves. Conclusions. Our observations reveal striking differences between the dynamics of normal and stenotic valves. Surprisingly, Doppler-derived mean-valve area correlated better with maximalanatomic area than with mean-anatomic area in patients with aortic stenosis. Discrepancies between duration of flow and valve opening could explain this phenomenon.
Impact of blood pressure on the Doppler echocardiographic assessment of severity of aortic stenosis
Heart, 2007
To investigate the impact of blood pressure (BP) on the Doppler echocardiographic (Doppler-echo) evaluation of severity of aortic stenosis (AS). Methods: Handgrip exercise or phenylephrine infusion was used to increase BP in 22 patients with AS. Indices of AS severity (mean pressure gradient (DP mean), aortic valve area (AVA), valve resistance, percentage left ventricular stroke work loss (% LVSW loss) and the energy loss coefficient (ELCo)) were measured at baseline, peak BP intervention and recovery. Results: From baseline to peak intervention, mean (SD) BP increased (99 (8) vs 121 (10) mm Hg, p,0.001), systemic vascular resistance (SVR) increased (1294 (264) vs 1552 (372) dyne6s/cm 5 , p,0.001) and mean (SD) transvalvular flow rate (Q mean) decreased (323 (67) vs 306 (66) ml/s, p = 0.02). There was no change in DP mean (36 (13) vs 36 (14) mm Hg, p = NS). However, there was a decrease in AVA (1.15 (0.32) vs 1.09 (0.33) cm 2 , p = 0.02) and ELCo (1.32 (0.40) vs 1.24 (0.42) cm 2 , p = 0.04), and an increase in valve resistance (153 (63) vs 164 (74) dyne6s/cm 5 , p = 0.02), suggesting a more severe valve stenosis. In contrast, % LVSW loss decreased (19.8 (6) vs 16.5 (6)%, p,0.001), suggesting a less severe valve stenosis. There was an inverse relationship between the change in mean BP and AVA (r =-0.34, p = 0.02); however, only the change in Q mean was an independent predictor of the change in AVA (r = 0.81, p,0.001). Conclusions: Acute BP elevation due to increased SVR can affect the Doppler-echo evaluation of AS severity. However, the impact of BP on the assessment of AS severity depends primarily on the associated change in Q mean , rather than on an independent effect of SVR or arterial compliance, and can result in a valve appearing either more or less stenotic depending on the direction and magnitude of the change in Q mean .
Journal of Diagnostic Medical Sonography, 1991
To assess the reliability of Doppler ultrasound for detecting serial changes in cardiac output in response to experimental interventions, the day to day variability of the minute distance of aortic flow was determined in seven normal subjects maintained in a tightly controlled environment with regard to diet and activities. Measurements were made at the same time on 5 to 6 sequential days from an apical window with use of both continuous wave and pulsed wave Doppler techniques. Two statistical measures of reliability were calculated, the intracIass coefficient of correlation (R), which varies between 0 (null reliability) and + 1 (perfect reliability), and the 95% confidence interval for the error-free value of a single measurement. For sequential measurements of arterial pressure, 24 h urinary volume and sodium excretion and body weight, the intracIass coefficients of correlation ranged from 0.85 to 0.99, indicating low day to day variability consistent with tight environmental control. Continuous and pulsed wave modes were proved equally and highly reliable for measuring minute distance of aortic flow. Doppler echocardiography is a safe, simple and accurate method for determining cardiac output in humans (1-4). We considered whether the method was sufficiently reliable to detect small changes in cardiac output over a period of days to weeks in humans undergoing clinical trials of antihypertensive regimens. Previous studies have attempted to deter-From the