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.
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.
Garcia
Damien
D
Laboratoire de Génie Biomédical, Institut de Recherches Cliniques de Montréal, Montreal, Quebec, Canada.
Dumesnil
Jean G
JG
Durand
Louis-Gilles
LG
Kadem
Lyes
L
Pibarot
Philippe
P
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