Quantification of low-gradient severe aortic stenosis using a hybrid approach combining Doppler echocardiography and thermodilution.

Philippe Unger, C. Dedobbeleer, E. Stoupel, N. Preumont, Jean-François Argacha, G. Berkenboom, Guy Van Camp

Onderzoeksoutput: Articlepeer review

1 Citaat (Scopus)

Samenvatting

BACKGROUND AND AIM OF THE STUDY:

Estimation of stroke volume in the left ventricular outflow tract (LVOT) is a main limitation to aortic valve area (AVA) calculation by echocardiography when using the continuity equation. In this study, the hypothesis was tested that a hybrid method using thermodilution-derived cardiac output measurement and simultaneous Doppler estimation of the systolic ejection period and transvalvular aortic velocities could be used to accurately assess AVA in patients with low-gradient severe aortic stenosis (AS).

METHODS:

Eighteen patients with low mean gradient (<40 mmHg) and nine patients with conventionally defined (> or = 40 mmHg) severe AS (<1 cm2), as assessed by the echocardiographic continuity equation (baseline echocardiography), underwent catheterization and simultaneous Doppler recording of trans-aortic velocities.

RESULTS:

The mean pressure gradient was slightly lower by Doppler in the catheterization laboratory (35.8 +/-15.7 mmHg) compared to baseline echocardiography (37.4 +/- 15.2 mmHg) and invasive (38.5 +/- 16.6 mmHg) measurements (both p <0.05). The AVA values were 0.72 +/- 0.12 cm2 during baseline echocardiography, 0.74 +/- 0.14 cm2 by catheterization, and 0.71 +/- 0.14 cm2 by the hybrid method (bias -0.01 +/- 0.11 cm2 and -0.02 +/- 0.08 cm2, versus echocardiography and catheterization, respectively; both p = NS).

CONCLUSION:

The hybrid method is reasonably accurate in assessing AVA in patients with low-gradient severe AS. Although the continuity equation should be used in routine clinical practice in most patients, this method could serve as an alternative when the LVOT diameter and/or velocities seem questionable.
Originele taal-2English
Pagina's (van-tot)271-278
Aantal pagina's8
TijdschriftJournal of Heart Valve Disease
Volume23
Nummer van het tijdschrift3
StatusPublished - mei 2014

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