Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity

Objectives We sought to obtain more coherent evaluations of aortic stenosis severity. Background The valve effective orifice area (EOA) is routinely used to assess aortic stenosis severity. However, there are often discrepancies between measurements of EOA by Doppler echocardiography (EOADop) and those by a catheter (EOAcath). We hypothesized that these discrepancies might be due to the influence of pressure recovery. Methods The relationship between EOAcath and EOADop was studied as follows: 1) in an in vitro model measuring the effects of different flow rates and aortic diameters on two fixed stenoses and seven bioprostheses; 2) in an animal model of supravalvular aortic stenosis (14 pigs); and 3) based on catheterization data from 37 patients studied by Schöbel et al. Results Pooling of in vitro, animal, and patient data showed a good correlation (r = 0.97) between EOAcath (range 0.3 to 2.3 cm2) and EOADop (range 0.2 to 1.7 cm2), but EOAcath systematically overestimated EOADop (24 ± 17% [mean ± SD]). However, when the energy loss coefficient (ELCo) was calculated from EOADop and aortic cross-sectional area (AA) to account for pressure recovery, a similar correlation (r = 0.97) with EOAcath was observed, but the previously noted overestimation was no longer present. Conclusions Discrepancies between EOAcath and EOADop are largely due to the pressure recovery phenomenon and can be reconciled by calculating ELCo from the echocardiogram. Thus, ELCo and EOAcath are equivalent indexes representing the net energy loss due to stenosis and probably are the most appropriate for quantifying aortic stenosis severity.