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Use of Peak Echocardiographic Doppler...
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Use of Peak Echocardiographic Doppler Gradient Across Ventricular Septal Defects Underestimates Right Sided Pressures in Patients with "SLOPED" Doppler Signals Marcus S. Schamberger MD, Anne G. Farrell MD, Sanjay R. Parikh MD, Robert K. Darragh MD, Timothy M. Cordes MD, Gregory J. Ensing MD. Indiana University, Indianapolis, IN. Journal of the American Society of Echocardiography 1999 Background: Most flow velocity profiles across ventricular septal defects (VSD) derived by Doppler echocardiography have a uniform, plateau-shaped signal. There is a high correlation between the instantaneous peak velocity of that signal and the catherization (cath) measured peak-to-peak gradient between the left ventricle (LV) and right ventricle (RV). Some patients (pts) with VSD were noted to have Doppler velocity profiles where the signal peaks early or late in systole, giving the appearance of a ?sloped? signal. The Doppler derived instantaneous peak gradient in these pts may not be a true estimate of the peak-to-peak gradient between the LV and RV. Methods: We studied 5 patients with ?sloped? VSD signals. During cardiac cath, simultaneous recordings of LV and RV pressures were obtained using 2 Fr. Millar catheters. Simultaneous continuous wave Doppler measurements across the VSD were recorded. Offline beat-to-beat analysis of Doppler signals and pressure tracings was performed. Peak, mean systolic and end-systolic velocities of the Doppler signals were measured and compared to the peak-to-peak cath gradient between the LV and RV. Results: The instantaneous peak echo gradient (39.3mm Hg ± 24.3mm Hg) in the five pts overestimated the peak-to-peak cath gradient (19.8mm Hg ± 11.9mm Hg) by an average of 19.5mm Hg. The correlation between peak echo and peak cath gradients had an r2 value of 0.76, (cath gradient = 0.56 x peak echo gradient - 2.23). The end-systolic echo gradient (15.9mm Hg ± 12.1mmHg) correlated closely with the peak cath gradient, with an r2 value of 0.98, (cath gradient = 0.98 x end-systolic echo gradient + 4.05). The mean systolic echo gradient (20.0mm Hg ± 15.5mm Hg) also correlated closely with the peak cath gradient, with an r2 value of 0.90, (cath gradient = 0.81 x mean systolic echo gradient + 3.60). Conclusion: The data shows that the instantaneous peak echo gradient clearly overestimates the cath derived peak-to-peak gradient in pts with sloped VSD signals. Mean systolic and end-systolic echo gradients correlate better with the peak-to-peak gradient between LV and RV determined at cath. Therefore, the use of peak echo gradient in pts with ?sloped? signals across the VSD leads to underestimation of the true RV and pulmonary artery systolic pressures. |
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