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Impact of left ventricular outflow tract flow acceleration on aortic valve area calculation in patients with aortic stenosis

Echo Research & Practice volume 6, pages 97–103 (2019)Cite this article

Abstract

Objective: Due to its circular shape, the area of the proximal left ventricular tract (PLVOT) adjacent to aortic valve can be derived from a single linear diameter. This is also the location of flow acceleration (FA) during systole, and pulse wave Doppler (PWD) sample volume in the PLVOT can lead to overestimation of velocity (V1) and the aortic valve area (AVA). Therefore, it is recommended to derive V1 from a region of laminar flow in the elliptical shaped distal LVOT (away from the annulus). Besides being inconsistent with the assumptions of continuity equation (CE), spatial difference in the location of flow and area measurement can result in inaccurate AVA calculation. We evaluated the impact of FA in the PLVOT on the accuracy of AVA by continuity equation (CE) in patients with aortic stenosis (AS).

Methods: CE-based AVA calculations were performed in patients with AS once with PWD-derived velocity time integral (VTI) in the distal LVOT (VTILVOT) and then in the PLVOT to obtain a FA velocity profile (FA-VTILVOT) for each patient. A paired sample t-test (P < 0.05) was conducted to compare the impact of FA-VTILVOT and VTILVOT on the calculation of AVA.

Result: There were 46 patients in the study. There was a 30.3% increase in the peak FA-VTILVOT as compared to the peak VTILVOT and AVA obtained by FA-VTILVOT was 29.1% higher than obtained by VTILVOT. p]Conclusion: Accuracy of AVA can be significantly impacted by FA in the PLVOT. LVOT area should be measured with 3D imaging in the distal LVOT.

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Authors and Affiliations

  1. Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA

    Andaleeb A. Ahmed MD MPH

  2. Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Robina Matyal MD, Feroze Mahmood MD, Ruby Feng BA, Graham B. Berry MD & Scott Gilleland MD

  3. Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA

    Kamal R. Khabbaz MD

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  1. Andaleeb A. Ahmed MD MPH
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Correspondence to Andaleeb A. Ahmed MD MPH.

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Ahmed, A.A., Matyal, R., Mahmood, F. et al. Impact of left ventricular outflow tract flow acceleration on aortic valve area calculation in patients with aortic stenosis. Echo Res Pract 6, 97–103 (2019). https://doi.org/10.1530/ERP-19-0017

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Echo Research & Practice

ISSN: 2055-0464

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