Document Detail

Impact of blood pressure on the Doppler echocardiographic assessment of severity of aortic stenosis.
MedLine Citation:
PMID:  17135222     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To investigate the impact of blood pressure (BP) on the Doppler echocardiographic (Doppler-echo) evaluation of severity of aortic stenosis (AS).
METHODS: Handgrip exercise or phenylephrine infusion was used to increase BP in 22 patients with AS. Indices of AS severity (mean pressure gradient (DeltaP(mean)), aortic valve area (AVA), valve resistance, percentage left ventricular stroke work loss (% LVSW loss) and the energy loss coefficient (ELCo)) were measured at baseline, peak BP intervention and recovery.
RESULTS: From baseline to peak intervention, mean (SD) BP increased (99 (8) vs 121 (10) mm Hg, p<0.001), systemic vascular resistance (SVR) increased (1294 (264) vs 1552 (372) dynexs/cm(5), p<0.001) and mean (SD) transvalvular flow rate (Q(mean)) decreased (323 (67) vs 306 (66) ml/s, p = 0.02). There was no change in DeltaP(mean) (36 (13) vs 36 (14) mm Hg, p = NS). However, there was a decrease in AVA (1.15 (0.32) vs 1.09 (0.33) cm(2), p = 0.02) and ELCo (1.32 (0.40) vs 1.24 (0.42) cm(2), p = 0.04), and an increase in valve resistance (153 (63) vs 164 (74) dynexs/cm(5), p = 0.02), suggesting a more severe valve stenosis. In contrast, % LVSW loss decreased (19.8 (6) vs 16.5 (6)%, p<0.001), suggesting a less severe valve stenosis. There was an inverse relationship between the change in mean BP and AVA (r = -0.34, p = 0.02); however, only the change in Q(mean) was an independent predictor of the change in AVA (r = 0.81, p<0.001).
CONCLUSIONS: Acute BP elevation due to increased SVR can affect the Doppler-echo evaluation of AS severity. However, the impact of BP on the assessment of AS severity depends primarily on the associated change in Q(mean), rather than on an independent effect of SVR or arterial compliance, and can result in a valve appearing either more or less stenotic depending on the direction and magnitude of the change in Q(mean).
Stephen H Little; Kwan-Leung Chan; Ian G Burwash
Publication Detail:
Type:  Journal Article     Date:  2006-11-29
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  93     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-15     Completed Date:  2007-07-20     Revised Date:  2013-06-07    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  848-55     Citation Subset:  AIM; IM    
Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
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MeSH Terms
Aortic Valve Stenosis / physiopathology*,  ultrasonography
Blood Flow Velocity / physiology
Blood Pressure / physiology*
Cardiotonic Agents / administration & dosage*
Echocardiography, Doppler
Exercise / physiology
Hand Strength
Infusions, Intravenous
Phenylephrine / administration & dosage*
Vascular Resistance / physiology
Reg. No./Substance:
0/Cardiotonic Agents; 59-42-7/Phenylephrine
Comment In:
Heart. 2007 Jul;93(7):780-2   [PMID:  17569800 ]
Heart. 2008 Apr;94(4):508; author reply 508   [PMID:  18347379 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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