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Doppler echocardiographic findings in adults with severe symptomatic valvular aortic stenosis

  • Catherine M. Otto
    Correspondence
    Address for reprints: Catherine M. Otto, MD, Division of Cardiology, RG-22, University of Washington, Seattle, Washington 98195.
    Affiliations
    From the Division of Cardiology and Balloon Valvuloplasty Coordinating Center, University of Washington, Seattle, Washington USA

    From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA

    From the Division of Cardiology, Duke University Medical Center, Durham, North Carolina USA
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  • Rick A. Nishimura
    Affiliations
    From the Division of Cardiology and Balloon Valvuloplasty Coordinating Center, University of Washington, Seattle, Washington USA

    From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA

    From the Division of Cardiology, Duke University Medical Center, Durham, North Carolina USA
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  • Kathryn B. Davis
    Affiliations
    From the Division of Cardiology and Balloon Valvuloplasty Coordinating Center, University of Washington, Seattle, Washington USA

    From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA

    From the Division of Cardiology, Duke University Medical Center, Durham, North Carolina USA
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  • Katherine B. Kisslo
    Affiliations
    From the Division of Cardiology and Balloon Valvuloplasty Coordinating Center, University of Washington, Seattle, Washington USA

    From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA

    From the Division of Cardiology, Duke University Medical Center, Durham, North Carolina USA
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  • Thomas M. Bashore
    Affiliations
    From the Division of Cardiology and Balloon Valvuloplasty Coordinating Center, University of Washington, Seattle, Washington USA

    From the Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota USA

    From the Division of Cardiology, Duke University Medical Center, Durham, North Carolina USA
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  • The Balloon Valvuloplasty Registry Echocardiographers
    Footnotes
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  • Author Footnotes
    ∗ See Appendix for list of Balloon Valvuloplasty Registry Echocardiographers.
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      Abstract

      Baseline echocardiographic data in 680 adults (mean age 78 years) undergoing balloon aortic valvuloplasty at 24 medical centers were analyzed to describe the degree of outflow obstruction in patients with symptomatic aortic stenosis. Maximal aortic jet velocity ranged from 2.3 to 6.6 m/s (mean 4.4 ± 0.8) and continuity equation valve area ranged from 0.1 to 1.4 cm2 (mean 0.6 ± 0.2). Of note, 36% had a jet velocity ≤4.0 m/s but only 3% had a valve area >1.0 cm2 due to a high prevalence of impaired systolic function (54%). Outflow tract diameter was poorly correlated with body surface area (p = 0.26), although the group mean diameter was smaller in women than in men (1.9 ± 0.2 vs 2.1 ± 0.3 cm, p = 0.0001).
      Mean pressure gradient was related closely to maximal gradient (r = 0.92) and to maximal jet velocity (mean ΔP = 2.4 V2 +0.75 mm Hg). Simpler measures of aortic stenosis severity were correlated with Doppler and invasive valve area as follows: maximal jet velocity (r = −0.36 and −0.32), mean gradient (r = −0.33 and −0.29), outflow tract to jet velocity ratio (r = 0.67 and 0.40), and the fractional shortening velocity ratio (r = 0.29 and 0.22).
      This study demonstrates marked variability in stenosis severity in symptomatic adults referred for balloon aortic valvuloplasty. The absence of a predictable relation between outflow tract diameter and body size emphasizes the importance of this measurement in each patient if definition of valve area is needed. The correlations between mean pressure gradient and maximal jet velocity, and between valve area and the velocity ratio support the potential use of these simpler measures of stenosis severity.
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