Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: prospective Doppler-catheterization correlation in 100 patients

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905.

Two-dimensional and Doppler echocardiography was performed prospectively in 100 patients with aortic stenosis who were undergoing clinically indicated cardiac catheterization. The purpose of this study procedure was to determine various Doppler variables predictive of the severity of aortic stenosis and to compare Doppler- and catheterization-derived aortic valve areas. Doppler-derived mean gradient correlated well with corresponding gradient by catheterization (r = 0.86). Peak Doppler aortic flow velocity greater than or equal to 4.5 m/s and Doppler-derived mean aortic gradient greater than or equal to 50 mm Hg were specific (93 and 94%, respectively) for severe aortic stenosis (defined as catheterization-derived aortic valve area less than or equal to 0.75 cm2) but were not sensitive (44 and 48%, respectively). Doppler-derived aortic valve area calculated by the continuity equation correlated well with catheterization-derived aortic valve area calculated by the Gorlin equation when either the time-velocity integral ratio (r = 0.83) or the peak flow velocity ratio (r = 0.80) between the left ventricular outflow tract and the aortic valve was used in the continuity equation. A velocity ratio of less than or equal to 0.25 alone was sensitive (92%) in detecting severe aortic stenosis. Therefore, use of various Doppler-derived values allows reliable noninvasive estimation of the severity of aortic stenosis.

This article has been cited by other articles:

				A. Shiran, S. Adawi, M. Ganaeem, and E. Asmer Accuracy and reproducibility of left ventricular outflow tract diameter measurement using transthoracic when compared with transesophageal echocardiography in systole and diastole Eur J Echocardiogr, October 2, 2008; (2008) jen254v1. [Abstract] [Full Text] [PDF]

				C. W. Akins, B. Travis, and A. P. Yoganathan Energy loss for evaluating heart valve performance. J. Thorac. Cardiovasc. Surg., October 1, 2008; 136(4): 820 - 833. [Abstract] [Full Text] [PDF]

				J. L. Gutierrez-Chico, J. L. Zamorano, E. Prieto-Moriche, R. A. Hernandez-Antolin, M. Bravo-Amaro, L. Perez de Isla, M. Sanmartin-Fernandez, J. A. Baz-Alonso, and A. Iniguez-Romo Real-time three-dimensional echocardiography in aortic stenosis: a novel, simple, and reliable method to improve accuracy in area calculation Eur. Heart J., May 2, 2008; 29(10): 1296 - 1306. [Abstract] [Full Text] [PDF]

				M. Enriquez-Sarano, V. T. Nkomo, and H. Michelena Principles and Practice of Echocardiography in Cardiac Surgery Card. Surg. Adult, January 1, 2008; 3(2008): 315 - 348. [Full Text]

				K. K. Stout and C. M. Otto Indications for Aortic Valve Replacement in Aortic Stenosis J Intensive Care Med, January 1, 2007; 22(1): 14 - 25. [Abstract] [PDF]

				H. Alkadhi, S. Wildermuth, A. Plass, D. Bettex, B. Baumert, S. Leschka, L. M. Desbiolles, B. Marincek, and T. Boehm Aortic Stenosis: Comparative Evaluation of 16-Detector Row CT and Echocardiography Radiology, July 1, 2006; 240(1): 47 - 55. [Abstract] [Full Text] [PDF]

				L. A. Cuniberti, P. G. Stutzbach, E. Guevara, G. G. Yannarelli, R. P. Laguens, and R. R. Favaloro Development of Mild Aortic Valve Stenosis in a Rabbit Model of Hypertension J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2303 - 2309. [Abstract] [Full Text] [PDF]

				R. A. Schroeder and J. B. Mark Is the Valve OK or Not? Immediate Evaluation of a Replaced Aortic Valve Anesth. Analg., November 1, 2005; 101(5): 1288 - 1291. [Abstract] [Full Text] [PDF]

				P. Lancellotti, F. Lebois, M. Simon, C. Tombeux, C. Chauvel, and L. A. Pierard Prognostic Importance of Quantitative Exercise Doppler Echocardiography in Asymptomatic Valvular Aortic Stenosis Circulation, August 30, 2005; 112(9_suppl): I-377 - I-382. [Abstract] [Full Text] [PDF]

				D. Messika-Zeitoun, M.-C. Aubry, D. Detaint, L. F. Bielak, P. A. Peyser, P. F. Sheedy, S. T. Turner, J. F. Breen, C. Scott, A. J. Tajik, et al. Evaluation and Clinical Implications of Aortic Valve Calcification Measured by Electron-Beam Computed Tomography Circulation, July 20, 2004; 110(3): 356 - 362. [Abstract] [Full Text] [PDF]

				G. Tarantini, P. Buja, R. Scognamiglio, R. Razzolini, G. Gerosa, G. Isabella, A. Ramondo, and S. Iliceto Aortic valve replacement in severe aortic stenosis with left ventricular dysfunction: determinants of cardiac mortality and ventricular function recovery Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 879 - 885. [Abstract] [Full Text] [PDF]

				U. N. Khot, G. M. Novaro, Z. B. Popovic, R. M. Mills, J. D. Thomas, E. M. Tuzcu, D. Hammer, S. E. Nissen, and G. S. Francis Nitroprusside in Critically Ill Patients with Left Ventricular Dysfunction and Aortic Stenosis N. Engl. J. Med., May 1, 2003; 348(18): 1756 - 1763. [Abstract] [Full Text] [PDF]

				D. Garcia, J. G. Dumesnil, L.-G. Durand, L. Kadem, and P. Pibarot Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity J. Am. Coll. Cardiol., February 5, 2003; 41(3): 435 - 442. [Abstract] [Full Text] [PDF]

				R. A. Levine and E. Schwammenthal Stenosis is in the eye of the observer: impact of pressure recovery on assessing aortic valve area J. Am. Coll. Cardiol., February 5, 2003; 41(3): 443 - 445. [Full Text] [PDF]

				M. F. Bellamy, P. A. Pellikka, K. W. Klarich, A. J. Tajik, and M. Enriquez-Sarano Association of cholesterol levels, hydroxymethylglutaryl coenzyme-a reductase inhibitor treatment, and progression of aortic stenosis in the community J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1723 - 1730. [Abstract] [Full Text] [PDF]

				J. J. Pereira, M. S. Lauer, M. Bashir, I. Afridi, E. H. Blackstone, W. J. Stewart, P. M. McCarthy, J. D. Thomas, and C. R. Asher Survival after aortic valve replacement forsevere aortic stenosis with low transvalvular gradients and severe left ventricular dysfunction J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1356 - 1363. [Abstract] [Full Text] [PDF]

				K. Rajappan, O. E. Rimoldi, D. P. Dutka, B. Ariff, D. J. Pennell, D. J. Sheridan, and P. G. Camici Mechanisms of Coronary Microcirculatory Dysfunction in Patients With Aortic Stenosis and Angiographically Normal Coronary Arteries Circulation, January 29, 2002; 105(4): 470 - 476. [Abstract] [Full Text] [PDF]

				P. Palka, S. Harrocks, A. Lange, D. J. Burstow, and M. F. O'Brien Primary Aortic Valve Replacement With Cryopreserved Aortic Allograft: An Echocardiographic Follow-Up Study of 570 Patients Circulation, January 1, 2002; 105(1): 61 - 66. [Abstract] [Full Text] [PDF]

				J.-L. Monin, M. Monchi, V. Gest, A.-M. Duval-Moulin, J.-L. Dubois-Rande, and P. Gueret Aortic stenosis with severe left ventricular dysfunction and low transvalvular pressure gradients: Risk stratification by low-dose dobutamine echocardiography J. Am. Coll. Cardiol., June 15, 2001; 37(8): 2101 - 2107. [Abstract] [Full Text] [PDF]

				E. Schwammenthal, Z. Vered, Y. Moshkowitz, B. Rabinowitz, Z. Ziskind, A. K. Smolinski, and M. S. Feinberg Dobutamine Echocardiography in Patients With Aortic Stenosis and Left Ventricular Dysfunction : Predicting Outcome as a Function of Management Strategy Chest, June 1, 2001; 119(6): 1766 - 1777. [Abstract] [Full Text] [PDF]

				H. M. Connolly, J. K. Oh, H. V. Schaff, V. L. Roger, S. L. Osborn, D. O. Hodge, and A. J. Tajik Severe Aortic Stenosis With Low Transvalvular Gradient and Severe Left Ventricular Dysfunction : Result of Aortic Valve Replacement in 52 Patients Circulation, April 25, 2000; 101(16): 1940 - 1946. [Abstract] [Full Text] [PDF]

				D. L. Milavetz, S. N. Hayes, S. A. Weston, J. B. Seward, C. J. Mullany, and V. L. Roger Sex Differences in Left Ventricular Geometry in Aortic Stenosis: Impact on Outcome Chest, April 1, 2000; 117(4): 1094 - 1099. [Abstract] [Full Text] [PDF]

				F ANTONINI-CANTERIN, P FAGGIANO, D ZANUTTINI, and F RIBICHINI Is aortic valve resistance more clinically meaningful than valve area in aortic stenosis? Heart, July 1, 1999; 82(1): 9 - 10. [Full Text] [PDF]

				J. M. Bernal, R. Martin-Duran, J. M. Rabasa, and J. M. Revuelta The CarboMedics ""Top-Hat"" supraannular prosthesis Ann. Thorac. Surg., May 1, 1999; 67(5): 1299 - 1303. [Abstract] [Full Text] [PDF]

				K Dennig, H J Nesser, D Hall, H U Haase, and A Schömig Determination of prestenotic flow volume using an automated method based on colour Doppler imaging for evaluating orifice area by the continuity equation: validation in a pulsatile flow model Heart, April 1, 1998; 79(4): 324 - 330. [Abstract] [Full Text]

				H. M. Connolly, J. K. Oh, T. A. Orszulak, S. L. Osborn, V. L. Roger, D. O. Hodge, K. R. Bailey, J. B. Seward, and A. J. Tajik Aortic Valve Replacement for Aortic Stenosis With Severe Left Ventricular Dysfunction: Prognostic Indicators Circulation, May 20, 1997; 95(10): 2395 - 2400. [Abstract] [Full Text]

				C. M. Otto, I. G. Burwash, M. E. Legget, B. I. Munt, M. Fujioka, N. L. Healy, C. D. Kraft, C. Y. Miyake-Hull, and R. G. Schwaegler Prospective Study of Asymptomatic Valvular Aortic Stenosis : Clinical, Echocardiographic, and Exercise Predictors of Outcome Circulation, May 6, 1997; 95(9): 2262 - 2270. [Abstract] [Full Text]

				J. A. Dearani, T. A. Orszulak, R. C. Daly, M. R. Phillips, F. A. Miller, G. K. Danielson, and H. V. Schaff Comparison of Techniques for Implantation of Aortic Valve Allografts Ann. Thorac. Surg., October 1, 1996; 62(4): 1069 - 1075. [Abstract] [Full Text]