Non-invasive Assessment of the Severity of Aortic Stenosis by Doppler Derived Aortic Valve Coefficient: A Retrospective Feasibility Study in Humans.
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Date
2015
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Abstract
Background: Accurate assessment of the severity of stenosis is critical in patients with aortic
stenosis. The ambiguities and imprecisions of the current diagnostic parameters can result in suboptimal
clinical decisions. In this feasibility study, we investigate the functional diagnostic
parameter AVC (Aortic Valve coefficient: ratio of the total transvalvular pressure drop to the
proximal dynamic pressure) in the non-invasive assessment of the severity of aortic stenosis by
correlating with the current diagnostic parameters. Methods and Results: AVC was calculated using Doppler measured diagnostic parameters
obtained from retrospective chart reviews. A theoretical pressure recovery correction was applied
to the pressure drop calculated from Doppler measurements to obtain AVC. A statistically
significant and strong combined linear correlation (r = 0.93, p<0.001) of AVC with the transvalvular
pressure drop and the left ventricular outflow tract velocity was observed. The mean values of AVC
were shown to better delineate moderate and severe stenosis (54% difference) than the mean
values of Doppler measured pressure drop and aortic valve area (22% and 25% difference,
respectively), when the patients were categorized based on the catheterization measured pressure
drop.
Conclusion: The feasibility of using pressure and flow measurements obtained from Doppler
measurements in a single combined diagnostic index for the assessment of aortic stenosis severity
has been evaluated. The nondimensional clinical parameter, AVC, is expected to account for the
variation in flow and pressure drop and thus improve the delineation of different grades of aortic
stenosis. AVC must be further evaluated in a controlled prospective study.
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Keywords
Aortic stenosis, Aortic stenosis severity, Doppler echocardiography, Aortic valve replacement
Citation
Paul Anup K, Effat Mohamed A, Paquin Jason J, Narayanan Arumugam, Helmy Tarek A, Arif Imran, Leesar Massoud A, Banerjee Rupak K. Non-invasive Assessment of the Severity of Aortic Stenosis by Doppler Derived Aortic Valve Coefficient: A Retrospective Feasibility Study in Humans. British Journal of Medicine and Medical Research. 2015; 8(2): 177-191.