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Limitations of Doppler measurement of volume flow in adults with aortic stenosis

  • Catherine M. Otto
  • Alan S. Pearlman
  • Keith A. Comess
  • A. Kim Saal
  • Carolyn L. Janko
  • Robyn R. Reamer
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 54)

Abstract

Transvalvular gradients, which can be measured by Doppler in patients with aortic stenosis, vary with volume flow. Therefore, we tested three Doppler methods for measuring stroke volume (SV) in adults with aortic stenosis undergoing catheterization. Doppler velocities and 2D echo images were recorded immediately post-cath, simultaneous with thermodilution (TD) cardiac output. Doppler stroke volume was calculated from vessel diameter and the integral of the flow velocity curve. Using pulmonary artery flow and diameter, agreement between Doppler and TD was good (r= 0.83, DOP= 1.1 TD + 5.2ml), but diameter could be recorded in only 15/48 (31%) patients. Mitral annular diameter and left ventricular inflow could be recorded in 41/48 (85%), but agreement with TD stroke volume was only fair (r = 0.63, DOP = 1.5 TD − 8.1ml). Moreover, the mitral annulus method was rendered inappropriate by the high prevalence of mitral regurgitation (83%) in this group. Finally, coexisting aortic insufficiency was present in over 80% of our patients and was more than trivial in 66%. In this situation, a measure of actual transaortic flow is needed since neither pulmonary artery flow nor left ventricular filling represents total transaortic flow. Ascending aortic volume flow cannot be measured because it is non-laminar.

To circumvent these difficulties, we measured left ventricular outflow tract (LVOT) diameter and flow just below the stenotic aortic valve. These measures were feasible in 47/49 (96%) patients. In the 38 patients with LV angiograms, the Doppler LVOT stroke volume was compared to angio stroke volume (r = 0.69, DOP = 0.59 Angio + 36.1 ml). In the last 12 patients, the correlation of the LVOT stroke volume with angio stroke volume was improved (r= 0.85), which may represent a learning effect.

We conclude that in adults with aortic stenosis
  1. 1.

    the pulmonary artery method measures TD-SV accurately, but it cannot be used in the majority of patients;

     
  2. 2.

    the mitral annulus method does not provide an accurate measure of volume flow; and

     
  3. 3.

    although the agreement between the LVOT method and angio-SV has not been ideal, this method does measure transaortic flow and can be recorded in nearly all patients, and so merits further evaluation.

     

Keywords

Stroke Volume Aortic Stenosis Mitral Regurgitation Mitral Annulus Left Ventricular Outflow Tract 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Martinus Nijhoff Publishers, Dordrecht 1986

Authors and Affiliations

  • Catherine M. Otto
  • Alan S. Pearlman
  • Keith A. Comess
  • A. Kim Saal
  • Carolyn L. Janko
  • Robyn R. Reamer

There are no affiliations available

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