title: Noninvasive quantitation of blood flow turbulence in patients with aortic valve disease using online digital computer analysis of Doppler velocity data.
abstract: Previous experimental studies have demonstrated that aortic valve disease is associated with significant downstream turbulence (T). In this study, we developed a noninvasive method on the basis of Doppler velocity recording for quantitating aortic blood flow T in patients with aortic valve disease. The instantaneous blood velocity at a point in the aorta is equal to the sum of a mean periodic velocity component with a random or turbulent velocity component. According to the ensemble average method, time mean absolute T intensity is the root-mean-square value of turbulent velocity averaged over time and T is better quantitated by the relative T intensity (TIr), which is the ratio of absolute T intensity to the ensemble average velocity averaged over time. We computed TIr in 18 patients with mild to severe aortic stenosis and in 13 healthy volunteers from instantaneous modal velocities of 70 cycle length-matched heart beats recorded in the proximal part of the descending aorta by pulsed Doppler using an ultrasound system with an output port for online digital data transfer into a microcomputer. TIr was greater in patients with aortic valve disease (18.4 +/- 5.1%, range 11.2%-28.9%) than in control patients (7.9 +/- 1.9%, range 4.8%-9.8%; P =.0001). In patients with aortic valve disease, TIr was better linearly related to the ratio of postvalvular aorta to valvular orifice cross-sectional areas (r = 0.89, P =.0001) than to other parameters of valve restriction: transvalvular pressure gradient (r = 0.78, P =.0001); valve area (r = -0.56, P =.01); and valve resistance (r = 0.72, P =.0002). Thus, T that can be computed noninvasively from direct digital transfer of Doppler velocity data appears to be linearly related to indices of aortic valve restriction. Our data support the concept of the postvalvular aorta to valvular orifice cross-sectional areas ratio as a new important hemodynamic parameter in patients with aortic valve disease.
authors.affiliation: University of Saint Etienne, France. isaaz@univ-st-etienne.fr
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
authors.forename: Jean François
authors.initials: JF
authors.lastname: Bruntz
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.forename: Daniel
authors.initials: D
authors.lastname: Winninger
authors.forename: Alexis
authors.initials: A
authors.lastname: Cerisier
authors.forename: Christian
authors.initials: C
authors.lastname: de Chillou
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.forename: Michel
authors.initials: M
authors.lastname: Lamaud
authors.forename: Gerard
authors.initials: G
authors.lastname: Ethevenot
authors.forename: Etienne
authors.initials: E
authors.lastname: Aliot
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D003201:Computers; D015150:Echocardiography, Doppler; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006349:Heart Valve Diseases / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009862:Online Systems; D012044:Regression Analysis; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology