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Continuous wave Doppler echocardiographic measurement of prosthetic valve gradients. A simultaneous Doppler-catheter
D J Burstow1, R A Nishimura, K R Bailey
1Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Insights
Continuous wave Doppler echocardiography accurately predicts pressure gradients across prosthetic valves. This study found high correlations between simultaneous Doppler and cardiac catheterization measurements for both mechanical and bioprosthetic valves.
Area of Science:
- Cardiovascular Medicine
- Echocardiography
- Medical Devices
Background:
- Previous studies correlating Doppler echocardiography with cardiac catheterization for prosthetic valve gradients were limited.
- These prior studies often focused on specific valve types or used non-simultaneous measurements.
Purpose of the Study:
- To assess the accuracy of continuous wave Doppler echocardiography in determining pressure gradients across prosthetic valves.
- To compare simultaneous Doppler-derived gradients with those obtained via cardiac catheterization.
Main Methods:
- Simultaneous measurements of pressure gradients were taken using both continuous wave Doppler echocardiography and dual-catheter cardiac catheterization in 36 patients.
- The study included 42 prosthetic valves: 20 aortic, 20 mitral, one tricuspid, and one pulmonary.
- Pressure tracings and Doppler flow velocity profiles were digitized to derive maximal and mean gradients.
Main Results:
- A high correlation was observed between maximal Doppler gradients and maximal catheter gradients (r=0.94).
- An even stronger correlation was found between mean Doppler gradients and mean catheter gradients (r=0.96).
- Similar high correlations were found for both mechanical and bioprosthetic valves, as well as for aortic and mitral prostheses.
Conclusions:
- Continuous wave Doppler echocardiography is a reliable and accurate method for predicting pressure gradients across prosthetic valves.
- The findings support the use of Doppler echocardiography as a valuable tool in the assessment of prosthetic valve function.
Abstract:
Studies correlating prosthetic valve gradients determined by continuous wave Doppler echocardiography with gradients obtained by cardiac catheterization have, to date, been limited to patients with mitral and tricuspid prostheses or have compared nonsimultaneous measurements. Simultaneous Doppler and catheter pressure gradients in 36 patients (mean age, 63 +/- 13 years) with 42 prosthetic valves (20 aortic, 20 mitral, one tricuspid, and one pulmonary) were studied. Catheter gradients were obtained using a dual-catheter technique. The simultaneous pressure tracings and Doppler flow velocity profiles were digitized at 10-msec intervals to derive the corresponding maximal and mean gradients. The correlation between the maximal Doppler gradient and the simultaneously measured maximal catheter gradient was 0.94 (SEE = 6), and that between the Doppler gradient and the simultaneously measured mean catheter gradient was 0.96 (SEE = 3). There were no significant differences in correlation between gradients for the 32 mechanical valves (maximal gradients: r = 0.95, SEE = 6; mean gradients: r = 0.96, SEE = 3) and the 10 bioprosthetic valves (maximal gradients: r = 0.89, SEE = 6; mean gradients: r = 0.93, SEE = 3). In patients with mitral prostheses, Doppler gradients correlated well with the corresponding catheter gradients obtained with direct measurement of left atrial pressure (maximal gradients: r = 0.96, SEE = 2; mean gradients: r = 0.97, SEE = 1.2). A close correlation between corresponding Doppler and catheter gradients also was found in patients with aortic prostheses (maximal gradients: r = 0.94, SEE = 6; mean gradients: r = 0.94, SEE = 3). Thus, continuous wave Doppler echocardiography can accurately predict the pressure gradient across prosthetic valves.