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CLINICAL STUDIES

"overestimation" of catheter gradients by doppler ultrasound in patients with aortic stenosis: a predictable manifestation of pressure recovery

^a Department of Cardiology, Vienna General Hospital, University of Vienna, Vienna, Austria
^* Center of Biomedical Research/Ludwig Boltzmann Research Institute of Cardiac Surgery, Vienna General Hospital, University of Vienna, Vienna, Austria

Manuscript received July 28, 1998; revised manuscript received January 5, 1999, accepted January 21, 1999.

Reprint requests and correspondence: Dr. Helmut Baumgartner, Department of Cardiology, Vienna General Hospital, University of Vienna, Währinger Gürtel 18-20, A-1090 Wien, Austria
hbaumgartner{at}pop3.kard.akh-wien.ac.at

OBJECTIVES

This study sought to evaluate whether pressure recovery can cause significant differences between Doppler and catheter gradients in patients with aortic stenosis, and whether these differences can be predicted by Doppler echocardiography.

BACKGROUND

Pressure recovery has been shown to be a source of discrepancy between Doppler and catheter gradients across aortic stenoses in vitro. However, the clinical relevance of this phenomenon for the Doppler assessment of aortic stenosis has not been evaluated in patients.

METHODS

Twenty-three patients with various degrees of aortic stenosis were studied with Doppler echocardiography and catheter technique within 24 h. Using an equation previously validated in vitro, pressure recovery was estimated from peak transvalvular velocity, aortic valve area and cross-sectional area of the ascending aorta and compared with the observed differences between Doppler and catheter gradients. Doppler gradients were also corrected by subtracting the predicted pressure recovery and then were compared with the observed catheter gradients.

RESULTS

Predicted differences between Doppler and catheter gradients due to pressure recovery ranged from 5 to 82 mm Hg (mean ± SD, 19 ± 16 mm Hg) and 3 to 54 mm Hg (12 ± 11 mm Hg) for peak and mean gradients, respectively. They compared well with the observed Doppler-catheter gradient differences, ranging from –5 to 75 mm Hg (18 ± 18 mm Hg) and –7 to 48 mm Hg (11 ± 13 mm Hg). Good correlation between predicted pressure recovery and observed gradient differences was found (r = 0.90 and 0.85, respectively). Both the noncorrected and the corrected Doppler gradients correlated well with the catheter gradients (r = 0.93–0.97). However, noncorrected Doppler gradients significantly overestimated the catheter gradients (slopes, 1.36 and 1.25 for peak and mean gradients, respectively), while Doppler gradients corrected for pressure recovery showed good agreement with catheter gradients (slopes, 1.03 and 0.96; standard error of estimate [SEE] 8.1 and 6.9 mm Hg; mean difference ± SD 0.4 ± 8.0 mm Hg and 1.1 ± 6.8 mm Hg for peak and mean gradients, respectively).

CONCLUSIONS

Significant pressure recovery can occur in patients with aortic stenosis and can cause discrepancies between Doppler and catheter gradients. However, pressure recovery and the resulting differences between Doppler and catheter measurements may be predicted from Doppler velocity, aortic valve area and size of the ascending aorta.

Abbreviations and Acronyms   SEE = Standard error of estimate

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