title: Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity.
abstract: OBJECTIVE
  We sought to obtain more coherent evaluations of aortic stenosis severity.
  
  
  BACKGROUND
  The valve effective orifice area (EOA) is routinely used to assess aortic stenosis severity. However, there are often discrepancies between measurements of EOA by Doppler echocardiography (EOA(Dop)) and those by a catheter (EOA(cath)). We hypothesized that these discrepancies might be due to the influence of pressure recovery.
  
  
  METHODS
  The relationship between EOA(cath) and EOA(Dop) was studied as follows: 1) in an in vitro model measuring the effects of different flow rates and aortic diameters on two fixed stenoses and seven bioprostheses; 2) in an animal model of supravalvular aortic stenosis (14 pigs); and 3) based on catheterization data from 37 patients studied by Schöbel et al.
  
  
  RESULTS
  Pooling of in vitro, animal, and patient data showed a good correlation (r = 0.97) between EOA(cath) (range 0.3 to 2.3 cm(2)) and EOA(Dop) (range 0.2 to 1.7 cm(2)), but EOA(cath) systematically overestimated EOA(Dop) (24 +/- 17% [mean +/- SD]). However, when the energy loss coefficient (ELCo) was calculated from EOA(Dop) and aortic cross-sectional area (A(A)) to account for pressure recovery, a similar correlation (r = 0.97) with EOA(cath) was observed, but the previously noted overestimation was no longer present.
  
  
  CONCLUSIONS
  Discrepancies between EOA(cath) and EOA(Dop) are largely due to the pressure recovery phenomenon and can be reconciled by calculating ELCo from the echocardiogram. Thus, ELCo and EOA(cath) are equivalent indexes representing the net energy loss due to stenosis and probably are the most appropriate for quantifying aortic stenosis severity.
authors.affiliation: Laboratoire de Génie Biomédical, Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada.
authors.forename: Damien
authors.initials: D
authors.lastname: Garcia
authors.forename: Jean G
authors.initials: JG
authors.lastname: Dumesnil
authors.forename: Louis-Gilles
authors.initials: LG
authors.lastname: Durand
authors.forename: Lyes
authors.initials: L
authors.lastname: Kadem
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
mesh_terms: D000818:Animals; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology*; D006328:Cardiac Catheterization; D004195:Disease Models, Animal; D015150:Echocardiography, Doppler; D006801:Humans; D066298:In Vitro Techniques; D008955:Models, Cardiovascular; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013552:Swine