Accurate assessment of aortic stenosis severity by Doppler echocardiography independent of aortic jet velocity.

Overview

The present investigation was designed to derive an accurate pulsed Doppler method of assessing aortic stenosis severity that does not rely on measurement of aortic jet velocity. Left ventricular ET and SV were determined from pulsed Doppler recordings of flow velocity at the aortic anulus in 44 mostly normotensive patients with aortic stenosis. Aortic valve area at catheterization ranged between 0.3 and 2.13 cm2. A predicted ET was derived from Doppler-determined SV with the use of a regression equation previously described by Harley et al. A significant inverse quadratic relation was observed between the ET difference (delta ET), defined as measured ET minus predicted ET, and valve area at catheterization (r = -0.87; valve area = 1.4 - 15 delta ET + 60 delta ET2; SEE = 0.23 cm2). An ET difference of greater than or equal to 0.060 second was 88% sensitive, 89% specific, and 89% accurate for detecting critical aortic stenosis. Thus the ET difference, derived from measurements of SV and ET by pulsed Doppler, is a sensitive index for detection of critical aortic stenosis that is independent of determination of aortic jet velocity. This index should complement the Doppler evaluation of aortic stenosis, especially in cases where interrogation of the stenotic jet with continuous wave Doppler is inadequate.