Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1988 May;59(5):551–555. doi: 10.1136/hrt.59.5.551

Limitations in assessing the severity of aortic stenosis by Doppler gradients.

R Danielsen 1, J E Nordrehaug 1, L Stangeland 1, H Vik-Mo 1
PMCID: PMC1276895  PMID: 3382566

Abstract

Continuous wave Doppler echocardiography was performed before cardiac catheterisation in 69 consecutive patients with suspected aortic stenosis. Agreement between the maximum and the mean Doppler gradients and catheterisation gradients was good. Doppler echocardiography, however, systematically underestimated the maximum and mean gradients, particularly in the high range. Stepwise regression analysis of the small pressure difference between the two methods showed that it could not be explained by age, sex, stroke volume, differences in heart rate, ejection fraction, the presence of coronary artery disease, or severity of aortic regurgitation. There was a negative curvilinear correlation between the maximum and mean Doppler gradients and the aortic valve areas that were measured at catheterisation in patients with pure aortic stenosis. The degree of correlation decreased when patients with concomitant aortic regurgitation were included. The scatter of gradients above and below the correlation line was large and this was caused by low and high transvalvar flow. These results show that the usefulness of Doppler gradients for judging the severity of aortic stenosis, both in relation to immediate diagnosis and follow up, is severely limited if transvalvar flow is not taken into account.

Full text

PDF
554

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Agatston A. S., Chengot M., Rao A., Hildner F., Samet P. Doppler diagnosis of valvular aortic stenosis in patients over 60 years of age. Am J Cardiol. 1985 Jul 1;56(1):106–109. doi: 10.1016/0002-9149(85)90575-2. [DOI] [PubMed] [Google Scholar]
  2. Croft C. H., Lipscomb K., Mathis K., Firth B. G., Nicod P., Tilton G., Winniford M. D., Hillis L. D. Limitations of qualitative angiographic grading in aortic or mitral regurgitation. Am J Cardiol. 1984 Jun 1;53(11):1593–1598. doi: 10.1016/0002-9149(84)90585-x. [DOI] [PubMed] [Google Scholar]
  3. Currie P. J., Seward J. B., Reeder G. S., Vlietstra R. E., Bresnahan D. R., Bresnahan J. F., Smith H. C., Hagler D. J., Tajik A. J. Continuous-wave Doppler echocardiographic assessment of severity of calcific aortic stenosis: a simultaneous Doppler-catheter correlative study in 100 adult patients. Circulation. 1985 Jun;71(6):1162–1169. doi: 10.1161/01.cir.71.6.1162. [DOI] [PubMed] [Google Scholar]
  4. GORLIN R., GORLIN S. G. Hydraulic formula for calculation of the area of the stenotic mitral valve, other cardiac valves, and central circulatory shunts. I. Am Heart J. 1951 Jan;41(1):1–29. doi: 10.1016/0002-8703(51)90002-6. [DOI] [PubMed] [Google Scholar]
  5. Hegrenaes L., Hatle L. Aortic stenosis in adults. Non-invasive estimation of pressure differences by continuous wave Doppler echocardiography. Br Heart J. 1985 Oct;54(4):396–404. doi: 10.1136/hrt.54.4.396. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Kennedy J. W., Trenholme S. E., Kasser I. S. Left ventricular volume and mass from single-plane cineangiocardiogram. A comparison of anteroposterior and right anterior oblique methods. Am Heart J. 1970 Sep;80(3):343–352. doi: 10.1016/0002-8703(70)90099-2. [DOI] [PubMed] [Google Scholar]
  7. Lewis J. F., Kuo L. C., Nelson J. G., Limacher M. C., Quinones M. A. Pulsed Doppler echocardiographic determination of stroke volume and cardiac output: clinical validation of two new methods using the apical window. Circulation. 1984 Sep;70(3):425–431. doi: 10.1161/01.cir.70.3.425. [DOI] [PubMed] [Google Scholar]
  8. Panidis I. P., Mintz G. S., Ross J. Value and limitations of Doppler ultrasound in the evaluation of aortic stenosis: a statistical analysis of 70 consecutive patients. Am Heart J. 1986 Jul;112(1):150–158. doi: 10.1016/0002-8703(86)90694-0. [DOI] [PubMed] [Google Scholar]
  9. Richards K. L., Cannon S. R., Miller J. F., Crawford M. H. Calculation of aortic valve area by Doppler echocardiography: a direct application of the continuity equation. Circulation. 1986 May;73(5):964–969. doi: 10.1161/01.cir.73.5.964. [DOI] [PubMed] [Google Scholar]
  10. Simpson I. A., Houston A. B., Sheldon C. D., Hutton I., Lawrie T. D. Clinical value of Doppler echocardiography in the assessment of adults with aortic stenosis. Br Heart J. 1985 Jun;53(6):636–639. doi: 10.1136/hrt.53.6.636. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Skjaerpe T., Hegrenaes L., Hatle L. Noninvasive estimation of valve area in patients with aortic stenosis by Doppler ultrasound and two-dimensional echocardiography. Circulation. 1985 Oct;72(4):810–818. doi: 10.1161/01.cir.72.4.810. [DOI] [PubMed] [Google Scholar]
  12. Yeager M., Yock P. G., Popp R. L. Comparison of Doppler-derived pressure gradient to that determined at cardiac catheterization in adults with aortic valve stenosis: implications for management. Am J Cardiol. 1986 Mar 1;57(8):644–648. doi: 10.1016/0002-9149(86)90851-9. [DOI] [PubMed] [Google Scholar]
  13. Zhang Y., Myhre E., Nitter-Hauge S. Noninvasive quantification of the aortic valve area in aortic stenosis by Doppler echocardiography. Eur Heart J. 1985 Dec;6(12):992–998. doi: 10.1093/oxfordjournals.eurheartj.a061820. [DOI] [PubMed] [Google Scholar]
  14. Zhang Y., Nitter-Hauge S., Ihlen H., Myhre E. Doppler echocardiographic measurement of cardiac output using the mitral orifice method. Br Heart J. 1985 Feb;53(2):130–136. doi: 10.1136/hrt.53.2.130. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES