Doppler Echocardiographic Profile and Indexes in the Evaluation of Aortic Coarctation in Patients Before and After Stenting
Ju-Le Tan, MBBS, MRCP*, ,
Sonya V. Babu-Narayan, MBBS, MRCP*,
Michael Y. Henein, MD, PhD ,
Michael Mullen, MD, MRCP* and
Wei Li, MD, PhD*,,*
* Adult Congenital Heart Disease Unit, Royal Brompton Hospital, London, United Kingdom
Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
National Heart Center, Singapore General Hospital, Singapore
View larger version (103K):
[in a new window]
|
Figure 1 (A) Continuous-wave Doppler across aortic coarctation with prominent "diastolic tail," the peak systolic velocity (SV), diastolic velocity at the end of ‘T’ wave (DV), and end-diastolic tail velocity at beginning of ‘Q’ wave (EDTV). (B) Systolic velocity half-time (SVHT), systolic pressure half-time (SPHT), diastolic velocity half-time (DVHT), and diastolic pressure half-time (DPHT). SVHT (ms): time taken for the systolic velocity to fall to half of its peak value; DVHT (ms): time taken for the diastolic velocity to fall to half of its value at the end of T-wave; SPHT (ms): time taken for the peak systolic pressure gradient (4[SV]2) to fall to half of its value; DPHT (ms): time taken for the diastolic pressure gradient (4[DV]2) to fall to half of its value.
|
|
View larger version (106K):
[in a new window]
|
Figure 2 Turbo spin echo cardiovascular magnetic resonance image of a patient with CoA, before coarctation and after stenting, and the calculated coarctation index (CoAi). X = diameter across the narrowest coarctation site; Y = diameter of the descending thoracic aorta at the diaphragmatic level.
|
|
View larger version (83K):
[in a new window]
|
Figure 3 (A) Continuous-wave Doppler of the descending thoracic aorta showing prominent "diastolic tail" pattern before coarctation stenting and regression to a smaller "diastolic tail" in the same patient after stenting. (B) Pulsed-wave Doppler of the abdominal aorta showing continuous-flow pattern before coarctation stenting and return to pulsatile flow in the same patient after coarctation stenting.
|
|
View larger version (33K):
[in a new window]
|
Figure 4 Relationship between coarctation (CoA) index and peak systolic gradient (a), end-diastolic tail velocity (b), diastolic velocity (c), systolic/diastolic velocity ratio (d), diastolic velocity half-time index (e), and diastolic pressure half-time index (f) in patients from group 1 before and after stenting. Filled circles = observed; line = inverse.
|
|
View larger version (17K):
[in a new window]
|
Figure 5 (A) Interactive dot diagram of diastolic velocity (DV) in patients with coarctation (group 1 prestenting) and in patients without significant coarctation (post-stenting/post-surgical group). Diastolic velocity >193 cm/s has a sensitivity (Sens) of 100% and a specificity (Spec) of 100%. (B) Interactive dot diagram of DV/systolic velocity ratio in coarctation (CoA) patients (group1 pre-stenting) and in patients without significant coarctation (post-stenting/post-surgical group). Diastolic velocity/systolic velocity ratio of >0.53 has a sensitivity of 100% and a specificity of 96%.
|
|
View larger version (16K):
[in a new window]
|
Figure 6 Receiver-operating characteristic (ROC) curves for comparison of diastolic velocity (DV), diastolic/systolic velocity (DVSV) ratio, and peak systolic pressure gradient (SPG) as indexes of coarctation severity. CI = confidence interval. Area under ROC curve for diastolic velocity (DV) = 1.000 (SE = 0.000, 95% CI = 0.904 to 1.00); area under ROC curve for diastolic/systolic velocity ratio (DV/SV ratio) = 0.997 (SE = 0.011, 95% CI = 0.898 to 1.000); area under ROC curve for peak systolic pressure gradient (SPG) = 0.994 (SE 0.016, 95% CI 0.892 to 1.000).
|
|
|
