Doppler echocardiography significantly underestimated left ventricular stroke work loss compared to invasive cardiac catheterization (26.5% vs 30.9%; p<0.0000001) in patients with aortic stenosis.
Observational (n=113)
Does Doppler echocardiography accurately estimate left ventricular stroke work loss compared to invasive cardiac catheterization in adult patients with aortic stenosis?
Doppler echocardiography significantly underestimates left ventricular stroke work loss in severe aortic stenosis compared to invasive catheterization, potentially confusing clinical assessment.
Absolute Event Rate: 26.5% vs 30.9%
p-value: p=<0.0000001
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.
Turto et al. (Tue,) conducted a observational in Aortic valve stenosis (n=113). Doppler echocardiography vs. Cardiac catheterization was evaluated on Left ventricular stroke work loss (SWL) (p=<0.0000001). Doppler echocardiography significantly underestimated left ventricular stroke work loss compared to invasive cardiac catheterization (26.5% vs 30.9%; p<0.0000001) in patients with aortic stenosis.