Influence of ejection fraction and valvular regurgitation on the accuracy of aortic valve area determination.
OBJECTIVE
To examine the influence of left ventricular dysfunction, aortic regurgitation, and mitral regurgitation on commonly used methods for aortic valve area (AVA) determination.


BACKGROUND
Each method for AVA determination has its inherent limitations.


METHODS
AVA determinations by transesophageal echocardiography (TEE) using planimetry, transthoracic echocardiography (TTE) with application of the continuity equation, and cardiac catheterization applying the Gorlin formula were performed in 74 patients with aortic stenosis. The severity of the aortic stenosis was defined by consensus of at least two methods. Over- or underestimation of AVA associated with ejection fraction, aortic regurgitation, mitral regurgitation, or severity of the aortic stenosis for each method in relation to the other two methods was assessed.


RESULTS
Mean AVAs were 1.05 +/- 0.51 by TEE, 1.06 +/- 0.51 by TTE, and 1.08 +/- 0.53 by cardiac catheterization. An overestimation of the severity of the aortic stenosis by the Gorlin formula in patients with moderate-to-severe aortic regurgitation as compared to TEE-derived data was found (P = 0.014). A similar trend of overestimation by catheterization in comparison with the TTE data was found. In the context of moderate-to-severe mitral regurgitation, AVA determination by TTE overestimated the degree of aortic stenosis as compared to TEE (P = 0.011) and cardiac catheterization (P = 0.023).


CONCLUSIONS
Overall mean AVA did not differ between methods, suggesting that these three methods are equally accurate in a nonselected clinical patient group. However, in the presence of significant aortic regurgitation, the two echocardiographic methods appear more accurate. Our observation of an overestimation of the severity of aortic stenosis by TTE in the presence of moderate-to-severe mitral regurgitation indicates that this possibility should be accounted for in clinical decisions based on TTE determinations of AVA.
Berglund
H
H
Division of Cardiology, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048, USA.
Kim
C J
CJ
Nishioka
T
T
Luo
H
H
Siegel
R J
RJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging; D006328:Cardiac Catheterization; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology