Prediction of the severity of aortic stenosis by Doppler aortic valve area determination: Prospective Doppler-catheterization correlation in 100 patients

Two-dimensional and Doppler echocardiography was performed prospectively in 100 patients with aortic stenosis who were undergoing clinically indicated cardiac catheterization. The purpose of this study procedure was to determine various Doppler variables predictive of the severity of aortic stenosis and to compare Doppler- and catheterization-derived aortic valve areas. Doppler-derived mean gradient correlated well with corresponding gradient by catheterization (r = 0.86). Peak Doppler aortic flow velocity ≥4.5 m/s and Doppler-derived mean aortic gradient ≥50 mm Hg were specific (93 and 94%, respectively) for severe aortic stenosis (defined as catheterization-derived aortic valve area ≤0.75 cm²) but were not sensitive (44 and 48%, respectively). Doppler-derived aortic valve area calculated by the continuity equation correlated well with catheterizationderived aortic valve area calculated by the Gorlin equation when either the time-velocity integral ratio (r = 0.83) or the peak flow velocity ratio (r = 0.80) between the left ventricular outflow tract and the aortic valve was used in the continuity equation. A velocity ratio of ≤0.25 alone was sensitive (92%) in detecting severe aortic stenosis. Therefore, use of various Doppler-derived values allows reliable noninvasive estimation of the severity of aortic stenosis.