Related Experiment Video
Updated: Aug 7, 2026

Noninvasive Determination of Vortex Formation Time Using Transesophageal Echocardiography During Cardiac Surgery
Published on: November 28, 2018
Doppler echocardiography markedly underestimates left ventricular stroke work loss in severe aortic valve stenosis
Heikki Turto1, Jyri Lommi, Markku Ventilä
1Division of Cardiology, Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, 00029 Helsinki, Finland.
Aims:
Left ventricular (LV) stroke work loss (SWL) is an index of aortic stenosis (AS) severity based on the energy loss concept. Traditionally known as an invasive measurement, SWL has also been determined noninvasively using Doppler echocardiography. The present work was done to compare the echocardiographic estimate against the standard invasive SWL.
Methods And Results:
We determined SWL in 113 adult patients with AS at cardiac catheterization (mean gradient as percentage of the LV mean systolic pressure) and by Doppler echocardiography (mean gradient as percentage of the sum of systolic cuff blood pressure and mean gradient). SWL averaged 26.5+/-0.6% by echocardiography vs 30.9+/-0.8% by catheterization (p<0.0000001). The underestimation by echocardiography was the worse the higher the invasive SWL was (p<0.00001). Echocardiographic SWL exceeding 25% (previously suggested cutoff) had a sensitivity of 64% and specificity of 74% to identify severe AS (Gorlin valve area<0.5 cm(2)/m(2)). Several patients with severe AS by valve area had echocardiographic SWL suggesting only mild AS.
Conclusions:
In AS, echocardiography gives a biased estimate of LV SWL with marked underestimation in severe disease. Echocardiographic SWL may confuse rather than improve the assessment of AS in clinical practice.
Related Concept Videos
Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
Imaging Studies for Cardiovascular System II:Types of Echocardiography
Types of Echocardiography
Transthoracic Echocardiography (TTE)
TTE is the most common type of echocardiogram which involves placing a transducer on the patient's chest, emitting sound waves to create heart images. TTE is invaluable for evaluating the heart's size, structure, and motion, making it particularly useful for diagnosing...
Imaging Studies for Cardiovascular System I:Echocardiography
Indications: Echocardiography is utilized to diagnose heart failure, valve disorders, and myocardial infarction. It also assesses cardiac structures' size, shape, and motion, evaluates...
Mitral Stenosis II: Clinical features and Diagnostic Tests
Aortic Regurgitation II: Clinical Features and Diagnostic Tests
Mitral Stenosis I: Introduction
