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European Journal of Echocardiography Advance Access originally published online on January 20, 2009
European Journal of Echocardiography 2009 10(4):532-536; doi:10.1093/ejechocard/jen333
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Nomograms for severity of aortic valve stenosis using peak aortic valve pressure gradient and left ventricular ejection fraction

Steffen P. Schoen*, Till F. Zimmermann, Charlotte Rosenberger, Gesa Elmer, Dirk Stolte, Carsten Wunderlich and Ruth H. Strasser

Department of Cardiology and Intensive Care, Heart Center, University of Technology, Dresden, Fetscherstr. 76, 01307 Dresden, Germany

Received 8 October 2008; accepted after revision 21 December 2008; online publish-ahead-of-print 20 January 2009.

* Corresponding author. Tel: +49 351 4501701; fax: +49 351 4501702. E-mail address: cardiology{at}email.de


  Abstract

Aims: Continuity equation to evaluate aortic valve area (AVACE) is critically dependent on accurate measurement of left ventricular outflow tract diameter and velocity. To circumvent these limitations, the present study aimed to generate nomograms for a facilitated estimation of aortic valve area using peak aortic valve pressure gradient ({Delta}pAv) and left ventricular ejection fraction (LVEF).

Methods and results: Two hundred and fifty-five subjects with non-invasively and invasively defined aortic valve stenosis (AS) formed the basis of this study. Basis of the nomograms was the correlation analysis between {Delta}pAv and AVA as estimated by AVACE within different LVEF groups. LVEF differed from 65.6 ± 1.8% (Group I, LVEF > 60%) to 34.5 ± 4.3% (Group IV, LVEF ≥ 30%). {Delta}pAv and AVA varied from 85.6 ± 19.5 mmHg and 0.69 ± 0.16 cm2 in Group I to 58.5 ± 15.9 mmHg and 0.73 ± 0.23 cm2 in Group IV ({Delta}pAv: P < 0.001). Mean AVACE showed no significant difference between the groups. Correlation between {Delta}pAv and AVACE was statistically significant with P < 0.001 in all subgroups (R2 between 0.72 and 0.76). Furthermore, a prospective estimation of AVA using the developed nomograms correlated very well with invasively determined AS using the Gorlin formula (R2 = 0.76, SEE = 0.21 cm2, bias 0.04 cm2).

Conclusion: The present study has established and confirmed a solid, easy to use nomogram-based method to accurately quantify severe AS.

Keywords: Aortic valve stenosis; Continuity equation; Nomogram


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