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Correlation of continuous-wave Doppler assessment of chronic aortic regurgitation with hemodynamics and angiography
R W Beyer1, M Ramirez, M A Josephson
1Department of Medicine, Wadsworth Veterans Administration Medical Center, Los Angeles, California.
Insights
The slope of continuous-wave Doppler signals better predicts aortic regurgitation severity than pressure half-time. This slope is influenced by left ventricular end-diastolic pressure and AR severity.
Area of Science:
- Cardiology
- Echocardiography
- Medical Imaging
Background:
- Chronic aortic regurgitation (AR) poses a significant clinical challenge.
- Accurate assessment of AR severity is crucial for patient management.
- Non-invasive methods are continually being refined for AR evaluation.
Purpose of the Study:
- To evaluate the utility of continuous-wave (CW) Doppler parameters in assessing the severity of chronic aortic regurgitation.
- To compare the predictive value of the CW Doppler signal slope and pressure half-time against established measures.
Main Methods:
- Cardiac catheterization and CW Doppler echocardiography were performed on 15 patients with chronic AR.
- The slope of the AR CW Doppler signal and pressure half-time were measured.
- Correlation with left ventricular end-diastolic pressure and angiographic severity was analyzed.
Main Results:
- The AR CW Doppler signal slope was significantly higher in severe AR compared to moderate or mild AR.
- Higher slopes correlated with elevated left ventricular end-diastolic pressure.
- Pressure half-time was shorter in severe AR but showed a weaker correlation with left ventricular end-diastolic pressure.
Conclusions:
- The slope of the CW Doppler signal is a more reliable predictor of AR severity than pressure half-time.
- Left ventricular end-diastolic pressure significantly influences the CW Doppler signal slope, in addition to AR severity.
Abstract:
Fifteen patients with chronic aortic regurgitation (AR) were studied by cardiac catheterization and continuous-wave (CW) Doppler echocardiography. The slope of the AR CW Doppler signal was higher in patients with severe AR (5.7 +/- 2.1 m/s2) than in those with moderate (2.5 +/- 1.3 m/s2) or mild (1.8 +/- 0.7 m/s2) AR (p less than 0.05). The slopes in patients with mild (less than or equal to 18 mm Hg), moderate (19 to 24 mm Hg) and severe (greater than 24 mm Hg) elevation of left ventricular end-diastolic pressure were significantly different (1.9 +/- 0.6, 3.3 +/- 1.2 and 7.1 +/- 0.4 m/s2, respectively, p less than 0.05). Patients with severe AR had shorter pressure half-times than those with mild AR (283 +/- 141 vs 820 +/- 393 ms, p less than 0.05). There was a significant correlation between the slope and left ventricular end-diastolic pressure (r = 0.80, p less than 0.001) and a weaker inverse correlation between pressure half-time and left ventricular end-diastolic pressure (r = -0.59, p less than 0.05). The end-diastolic pressure gradient estimated from CW Doppler using a simplified Bernoulli equation correlated poorly with the catheter measured gradient (r = 0.59, p less than 0.02). The slope of the CW Doppler signal is a better predictor of severity than pressure half-time and is affected by left ventricular end-diastolic pressure in addition to angiographic severity of AR.