Doppler echocardiographic measurement of aortic valve area in aortic stenosis: a noninvasive application of the Gorlin formula

Thirty adult patients with aortic stenosis had Doppler echocardiography within 1 day of cardiac catheterization. Noninvasive measurement of the mean transaortic pressure gradient was calculated by applying the simplified Bernoulli equation to the continuous wave Doppler transaortic velocity recording. Stroke volume was measured noninvasively by multiplying the systolic velocity integral of flow in the left ventricular outflow tract (obtained by pulsed Doppler ultrasonography) by the cross-sectional area of the left ventricular outflow tract (measured by two-dimensional echocardiography). Non-invasive measurement of aortic valve area was calculated by two methods. In method 1, the Gorlin equation was applied using Doppler-derived mean pressure gradient, cardiac output and systolic ejection period. Method 2 used the continuity equation. These noninvasive measurements were compared with invasive measurements using linear regression analysis, and mean pressure gradients correlated well (r = 0.92). Aortic valve area by either noninvasive method also correlated well with cardiac catheterization values (method 1, r = 0.87; method 2, r = 0.88). The sensitivity of Doppler detection of critical aortic stenosis was 0.86, with a specificity of 0.88 and a positive predictive value of 0.86. Cardiac output measured nonsimultaneously showed poor correlation (r = 0.51). Doppler echocardiography can distinguish critical from noncritical aortic stenosis with a high degree of accuracy. Measurement of aortic valve area aids interpretation of Doppler-derived mean pressure gradient data when the gradients are in an intermediate range (30 to 50 mm Hg).

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