Læknablaðið - 15.11.1988, Page 44

384
LÆKNABLAÐIÐ
túlka gætilega hjá sérhverjum sjúklingi vegna
mikils breytileika í ósæðarlokuflæði (21). Frekari
þróun Doppler aðferðarinnar mun væntanlega
gera kleift að ákvarða hið eiginlega
ósæðarlokuflatarmál óblóðugt (5, 17, 19).
SUMMARY
Continuous-wave Doppler echocardiography was
performed in 30 consequtive adult patients (18 maies)
with suspected aortic stenosis (AS) within 48 hours prior
to cardiac catheterisation. The mean age was 63 ± 10
years (range 33-75 years); 28 (93%) of the patients were
>50 years. The maximal Doppler and catheterisation
gradients were similar and correlated closely (r = 0.96).
Both these maximal gradients were different from, and
significantly higher than the traditional peak-to-peak
gradients at cátheterisation (p< 0.001). The mean
Doppler and catheterisation gradients showed a close
correlation (r = 0.93), but the mean Doppler gradients
were on the average slightly lower than the mean
catheterisation gradients (Y = 1.03X-6.1, p<0.001). A
curvilinear regression function described the
relationship of both the maximal and the mean Doppler
gradients to the aortic valve area (AVA) indexes (cmVm1)
at catheterisation (r = 0.80 and r = 0.78, respectively).
Thus, significant AS, defined as an AVA index of <0.5
cmVm1, was usually represented by maximal and mean
Doppler gradients of >54 and >33 mmHg,
respectively. However, a considerable range of Doppler
gradients corresponded to a given AVA index,
illustrating the importance of also considering the
influence of transvalvular aortic flow, when assessing
the severity of AS.
HEIMILDIR
1. Hatle L, Angelsen B, Tromsdal A. Noninvasive
assessment of aortic stenosis by Doppler
ultrasound. Br Heart J 1980; 43: 284-92.
2. Stamm RB, Martin RP. Quantification of pressure
gradients across stenotic valves by Doppler
ultrasound. JACC 1983; 2: 707-18.
3. Berger M, Berdoff RL, Gallerstein PE, Goldberg E.
Evaluation of aortic stenosis by continuous wave
Doppler ultrasound. JACC 1984; 3: 150-6.
4. Warth DC, Stewart WJ, Block PC, Weyman AE. A
new method to calculate aortic valve areas without
left heart catheterization. Circulation 1984; 70:
978-83.
5. Kosturakis D, Allen HD, Goldberg SJ, Sahn DJ,
Valdes-Cruz LM. Noninvasive quantification of
stenotic semilunar valve areas by Doppler
echocardiography. JACC 1984; 3: 1256-62.
6. Simpson IA, Houston AB, Sheldon CD, Hutton I,
Lawrie TDV. Clinical value of Doppler
echocardiography in the assessment of adults with
aortic stenosis. Br Heart J 1985; 53: 636-9.
7. Teien D, Erikson P. Quantification of transvalvular
pressure differences in aortic stenosis by Doppler
ultrasound. Int J Cardiol 1985; 7: 121-6.
8. Krafchek J, Robertson JH, Radford M, Adams D,
Kisslo J. A reconsideration of Doppler assessed
gradients in suspected aortic stenosis. Am Heart J
1985; 110: 765-73.
9. Agatson 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: 106-9.
10. Currie PJ, Seward JB, Reeder GS, et al.
Continuous-wave Doppler echocardiographic
assessment of severity of calcific aortic stenosis: a
simultaneous Doppler-catheter correlative study in
100 adult patients. Circulation 1985; 71: 1162-9.
11. Hegranæs L, Hatle L. Aortic stenosis in adults.
Non-invasive estimation of pressure difference by
continuous wave Doppler echocardiography. Br
Heart J 1985; 54: 396-404.
12. Yeager M, Yock PG, Popp RL. Comparison of
Doppler-derived pressure gradients to that
determined at cardiac catheterization in adults with
aortic valve stenosis: implications and
management. Am J Cardiol 1986; 57: 644-8.
13. Hatle L. Assessment of aortic stenosis with Doppler
ultrasound (Editorial note). Int J Cardiol 1985;
127-8.
14. Gorlin R, Gorlin SG. Hydrolic formula for
calculation of the area of the stenotic mitral valve,
other cardiac valves, and central circulatory shunts.
I. Am Heart J 1951; 41: 1-29.
15. Zar JH. Biostatistical analysis. Englewood Cliffs,
NJ, Prentice. Hall, 1974.
16. Lewis JF, Kuo LC, Nelson JG, Limacher MC,
Quinones MA. Pulsed Doppler echocardiographic
determination of stroke volume and cardiac output:
clinical validation of two new methods using the
apical window. Circulation 1984; 70: 425-31.
17. Zhang Y, NitterHauge S, Ihlen H, Myhre E.
Doppler echo-cardiographic measurements of
cardiac output using the mitral orfice method. Br
Heart J 1985; 53: 130-6.
18. Tortoledeo FA, Quinones MA, Fernandez GC,
Waggoner AD, Winters WL. Quantification of left
ventricular volumes by two-dimensional
echocardiography: a simplified and accurate
approach. Circulation 1983; 67: 579-84.
19. Skjærpe T, Hegranæs L, Hatle L. Noninvasive
estimation of valve area in patients with aortic
stenosis by Doppler ultrasound and
two-dimensional echocardiography. Circulation
1985; 72: 810-18.
20. Hatle L, Angelsen B. Doppler ultrasound in
cardiology. Philadelphia, Lea & Febiger, 1985.
21. Danielsen R, Nordrehaug JE, Stangeland L,
Vik-Mo H. Limitations in assessing the severity of
aortic stenosis by Doppler gradients. Br Heart J
1988; 59: 551-5.