Systematic correlation of continuous-wave Doppler and hemodynamic measurements in patients with aortic stenosis.

The purpose of this study was to compare estimates of pressure gradients obtained from continuous-wave (CW) Doppler recordings with direct pressure measurements derived from cardiac catheterization in patients with aortic stenosis. Forty patients who underwent cardiac catheterization for evaluation of aortic stenosis were prospectively studied with CW Doppler spectral recordings of the aortic valve prior to catheterization. Thirty-three patients underwent a second Doppler examination simultaneously with pressure recordings in the catheterization laboratory. Nineteen of the patients had catheterization pressures measured using high-fidelity, micromanometer-tip catheters. Doppler and pressure tracings were digitized using a microprocessor-based computer with a software program which allowed for calculation of maximal instantaneous, mean, and peak-to-peak gradients, plus ejection and acceleration times. Maximal instantaneous gradient by CW Doppler showed an excellent correlation with maximal instantaneous catheterization gradient (r = 0.93, SEE = 9 mm Hg). The correlation of maximal instantaneous Doppler gradient with peak-to-peak catheterization gradient was also linear (r = 0.85, SEE = 12 mm Hg), but there was a consistent overestimation of peak-to-peak gradient in 38 of 40 cases (mean = 17 mm Hg). Mean gradient as calculated by the two techniques correlated best of all measurements performed (r = 0.95, SEE = 6 mm Hg). When patients were grouped into subsets of mild (0 to 25 mm Hg), moderate (25 to 50 mm Hg), and severe (greater than 50 mm Hg) levels of stenosis, the correlation of maximal instantaneous Doppler and peak-to-peak catheterization gradients were r = 0.22, 0.44, and 0.77, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative accuracy of two-dimensional echocardiography and Doppler pressure half-time methods in assessing severity of mitral stenosis in patients with and without prior commissurotomy.

This study was undertaken to compare the accuracies of the two-dimensional echocardiographic (2DE) and Doppler pressure half-time methods for the noninvasive estimation of cardiac catheterization measurements of mitral valve area in patients with pure mitral stenosis both with and without a previous commissurotomy. Data were retrospectively obtained from 74 consecutive patients who underwent cardiac catheterization within a 30 month period for evaluation of mitral stenosis, and who had two-dimensional echocardiograms performed before catheterization. Six patients (8.1%) had technically inadequate 2DE images and their data were excluded from analysis. Two of these patients had undergone commissurotomy, while the remaining four had not. Continuous-wave Doppler echocardiographic examinations were attempted in 45 patients and adequate measurements of pressure half-times were obtained in all patients studied. Mitral valve area by two-dimensional echocardiography was measured as the planimetered area along the inner border of the smallest mitral orifice visualized during short-axis scanning, while pressure half-time was calculated as the interval between the peak transmitral velocity and velocity/square root 2 as measured from the envelope of the Doppler spectral signal. Calculations from catheterization represented the minimal valve area at rest as derived from the Gorlin formula with the use of pressure gradients and thermodilution measurements of cardiac output. Thirty-seven of the patients had had a previous mitral commissurotomy a mean of 11.2 +/- 5.4 years before, while the remaining 37 patients were previously unoperated. Mean valve area as determined at catheterization for the total group of patients ranged from 0.37 to 2.30 cm2 (mean = 1.08 +/- 0.42 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)

Accuracy of combined two-dimensional echocardiography and continuous wave Doppler recordings in the estimation of pressure gradient in right ventricular outlet obstruction.

Fifteen patients (median age 8.5 years) with fixed right ventricular outflow tract obstruction were evaluated by two-dimensional echocardiographically directed continuous wave Doppler ultrasound within 24 hours of cardiac catheterization. Pulmonary artery blood velocity measurements were determined from a real time spectral display of pulmonary artery flow profile and converted to pressure drop utilizing a modified Bernoulli equation. Use of both parasternal and subcostal imaging permitted more accurate detection of maximal flow velocity than did use of either approach alone. Gradients estimated from Doppler recordings correlated well with those measured at cardiac catheterization (correlation coefficient = 0.95, standard error of the estimate = 7.9 mm Hg) with a trend to slight underestimation of gradient in more severe obstruction. In three patients with combined valvular and subvalvular stenosis and one patient with right ventricular outlet obstruction due totally to a ventricular septal aneurysm, Doppler estimation of gradient provided an accurate assessment of total right ventricular-pulmonary artery gradient. Thus, continuous wave Doppler ultrasound combined with two-dimensional echocardiography provides a reliable noninvasive method of estimating pressure gradient in patients with right ventricular outflow tract obstruction.