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Non-invasive determination of the systolic peak-to-peak gradient in children with aortic stenosis: validation of a mathematical model

Published online by Cambridge University Press:  19 August 2008

Valter C. Lima ,
Evan Zahn ,
Christine Houde ,
Jeffrey Smallhorn ,
Robert M. Freedom  and
Lee N. Benson
Valter C. Lima
Affiliation:
Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Evan Zahn
Affiliation:
Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Christine Houde
Affiliation:
Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Jeffrey Smallhorn
Affiliation:
Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Robert M. Freedom
Affiliation:
Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
Lee N. Benson*
Affiliation:
Department of Pediatrics, Division of Cardiology, The Variety Club Cardiac Catheterization Laboratories, The Hospital for Sick children, The University of Toronto School of Medicine, Toronto, Ontario, Canada.
*
Dr Lee N Benson, The Hospital for Sick Children, 555 University Avenue, Room 4515, Toronto, Ontario, Canada, ZP M5G 1X8 Tel (416) 513–6141, Fax (416)813–7547, E-mail benson@sickkids.on.ca
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Abstract

Doppler derived systolic pressure gradients have become widely applied as noninvasively obtained estimates of the severity of aortic valvar stenosis. There is little correlation, however, between the Doppler derived peak instantaneous gradient and the peak-to-peak gradient obtained at catheterisation, the latter being the most applied variable to determine severity in children. The purpose of this study was to validate a mathematical model based on data from catheterisation which estimates the peak-to-peak gradient from variables which can be obtained by noninvasive means (Doppler derived mean gradient and pulse pressure), according to the formula: peak-to-peak systolic gradient=6.02+1.49*(mean gradient)−0.44*(pulse pressure). Simultaneous cardiac catheterization and Doppler studies were performed on 10 patients with congenital aortic valvar stenosis. Correlations between the gradients measured at catheter measured, and those derived by Doppler, were performed using linear regression analysis. The mean gradients correlated well (y=0.67 × + 11.11, r=0.87, SEE=6 mm Hg, p=0.001). The gradients predicted by the formula also correlated well with the peak-to-peak gradients measured at catheter (y=0.66 × + 14.44, r=0.84, SEE=9 mm Hg, p=O.002). The data support the application of the model, allowing noninvasive prediction of the peak-to-peak gradient across the aortic valvar stenosis.

Keywords

Aortic stenosisDoppler studyhemodynamicscongenital heart defects
Type
Original Articles
Information
Cardiology in the Young , Volume 10 , Issue 2 , March 2000 , pp. 115 - 119
Copyright
Copyright © Cambridge University Press 2000

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References

1.Keane, JF, Driscoll, DJ, Gersony, WM, Hayes, CJ, Kidd, L, O'Fallon, WM, Picroni, DR, Wolfe, RR, Weidman, WH. Second natural history study of congenital heart defects. Results of treatment of patients with aortic valvar stenosis. Circulation 1993; 87(2 Suppl): 116–27Google ScholarPubMed
2.Berger, M, Berdoff, RL, Gallerstein, PE, Goldberg, E. Evaluation of aortic stenosis by continuous wave Doppler ultrasound. J Am Coil Cardiol 1984; 3: 150–156CrossRefGoogle ScholarPubMed
3.Currie, PJ, Hagler, DJ, Seward, JB, Reeder, GS, Fyfe, DA, Bove, AA, Tajik, AJ. Instantaneous pressure gradient: simultaneous Doppler and dual catheter correlative study. J Am Coil Cardiol 1996; 7: 800–806CrossRefGoogle Scholar
4.Gordon, JB, Folland, ED. Analysis of aortic valve gradients by transeptal technique: implications for noninvasive evaluation. Cath Cardiovasc Diagn 1989; 17: 144–151CrossRefGoogle Scholar
5.Beckman, RH, Rocchini, AP, Gilion, JH, Mancini, GBJ. Hemodynamics determinants of the peak systolic left ventricular-aortic pressure gradient in children with valvar aortic stenosis. Am J Cardiol 1992; 69: 813–815CrossRefGoogle Scholar
6.Wright, SB; Wienecke, MM; Meyer, KB; McKay, CA; Wiles, HB. Correlation of pediatric echocardiographic Doppler and catheter-derived valvar aortic stenosis gradients and the influence of aortic regurgitation. Am J Cardiol 1996 77: 663–665CrossRefGoogle ScholarPubMed
7.Bengur, AR, Snider, AR, Server, GA, Peters, J, Rosenthal, A. Usefulness of the Doppler mean gradient in evaluation of children with aortic valve stenosis and comparison to gradient at catheterization. Am J Cardiol 1989; 64: 756–761CrossRefGoogle ScholarPubMed
8.Agatston, AS, Chengot, M, Rao, A, Hildner, F, Samet, P. Doppler diagnosis of valvular aortic stenosis in patients over 60 years of age. Am J Cardiol 1985; 56: 106–109CrossRefGoogle ScholarPubMed
9.Nishimura, V.A, Holmes, DR, Reeder, GS, Orsulak, TA, Bresnahan, JF, Ilstrup, DM, Tajik, AJ. Doppler evaluation of results of percutaneous aortic balloon valvuloplasty in calcific aortic stenosis. Circulation 1988; 8: 791–799CrossRefGoogle Scholar
10.Colan, SD. Fujii, A. Borow, KM. MacPherson, D. Sanders, SP. Noninvasive determination of systolic, diastolic and end systolic blood pressure in neonates, infants and young children: comparison with central aortic pressure measurements. Am J Cardiol 1983; 52: 867–870CrossRefGoogle ScholarPubMed