Comparison of simultaneous invasive and noninvasive measurements of pressure gradients in congenital aortic valve stenosis.
OBJECTIVE
Congenital aortic valve stenosis is a common problem in pediatric cardiology. The catheter peak to peak systolic gradient is the accepted standard used for prognosis and intervention, but noninvasive correlation in pediatric patients is frequently associated with underestimation or overestimation of this gradient. The purpose of this study was to compare different noninvasive measurements with simultaneous catheter gradients to identify which best predicts the catheter peak to peak gradient.


METHODS
Twenty-five simultaneous Doppler and catheter measurements of aortic stenosis gradient were performed in 14 children (all 14 before valvuloplasty and 11 after valvuloplasty). Noninvasive estimates of pressure gradient were compared with catheter measurements with linear regression and Bland-Altman analysis.


RESULTS
The Doppler peak instantaneous pressure gradient overestimated the catheter peak to peak gradient but correlated well with the catheter peak instantaneous gradient. The Doppler mean systolic gradient correlated well with the catheter peak to peak gradient at low gradients and underestimated higher catheter gradients but agreed well at all levels with the catheter mean gradient. The modification of a catheter-derived correlation equation produced good correlation with the catheter peak to peak gradient (slope, 1.14; intercept, -1.8; R, 0.92), as did the use of estimated pressure recovery (slope, 1.04; intercept, 5.0; R, 0.94), calculated from a defined fluid mechanic equation.


CONCLUSIONS
The catheter peak to peak gradient can be accurately estimated noninvasively using estimated pressure recovery or correlation equations incorporating Doppler measurements.
Barker
Piers C A
PC
University of Michigan Congenital Heart Center, Ann Arbor 48109, USA.
Ensing
Gregory
G
Ludomirsky
Achiau
A
Bradley
David J
DJ
Lloyd
Thomas R
TR
Rocchini
Albert P
AP
D000293:Adolescent; D000328:Adult; D001024:Aortic Valve Stenosis / Q000151:congenital* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D015150:Echocardiography, Doppler; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011237:Predictive Value of Tests; D013599:Systole / Q000502:physiology