Author + information
- Received June 20, 1988
- Revision received August 31, 1988
- Accepted October 5, 1988
- Published online March 1, 1989.
- Catherine M. Otto, MD, FACC∗,
- Alan S. Pearlman, MD, FACC and
- Carolyn L. Gardner, RDMS
- ↵∗Address for reprintsCatherine M. Otto, MD, Division of Cardiology, RG-22, University of Washington, Seattle, Washington 98195.
Doppler echocardiography was used to follow the hemodynamic severity of aortic stenosis. First, the reproducibility of repeat recordings (mean interval 28 ± 36 days) of aortic jet velocity, made by two independent observers, was tested in 38 adults with aortic stenosis and unchanged clinical status. The two recordings of maximal velocity correlated well (r = 0.96, y = 0.88x + 0.46m/s, SEE = 0.21 m/s) with a mean coefficient of variation of 3.2%. Repeat recording of left ventricular outflow tract velocity by two independent observers in 10 other patients with aortic stenosis also correlated well (r = 0.94, y = 1.06x + 0.0 m/s, SEE = 0.06 m/s) with a mean coefficient of variation of 4.6%.
Next, Doppler echocardiography was used to study 42 patients with aortic stenosis (mean age 66 years) over a follow-up interval of 6 to 43 months (mean 20). Maximal aortic jet velocity increased by 0.36 m/s per year (range −0.3 to +1.0 m/s per year). Mean transaortic pressure gradient changed by −7 to +23 (mean 8) mm Hg/year. Aortic valve area by the continuity equation (n = 25) decreased by 0 to 0.5 cm2/year (mean decrease 0.1 cm2/year). year patients had a worsening of stenosis (decrease in valve area) even though they had no change or a decrease in pressure gradient, because of concurrent decreases in transaortic volume flow.
Twenty-one patients (50%) developed new or progressive symptoms of aortic stenosis necessitating valve replacement. These patients had a higher maximal aortic jet velocity at follow-up (4.5 versus 3.9 m/s, p < 0.01) and a greater rate of increase in mean pressure gradient (15 versus 7 mm Hg/year, p < 0.01) than did those who remained asymptomatic; however, there were no significant differences in age, follow-up interval or maximal aortic jet velocity at entry.
It is concluded that Doppler echocardiographic measures of aortic stenosis severity are reproducible. The rate of change of transaortic pressure gradient varies among patients and the gradient may not increase even when stenosis severity worsens. Although stenosis severity progresses more rapidly in patients who develop symptoms requiring valve replacement, these patients cannot be identified at the initial study.
☆ We thank Robyn P. Reamer, Carol D. Kraft and Michelle C. Fujioka for performing the echocardiograms and Sharon Kemp for preparing the manuscript.
- Received June 20, 1988.
- Revision received August 31, 1988.
- Accepted October 5, 1988.