Accuracy of the Single Cycle Length Method for Calculation of Aortic Effective Orifice Area in Irregular Heart Rhythms - 01/03/19
Abstract |
Introduction |
In irregular heart rhythms, echocardiographic calculation of aortic effective orifice area (EOA) requires averaging measurements from multiple cardiac cycles. Whether a single cycle length method can be used to calculate aortic EOA in aortic stenosis with nonsinus rhythms is not known.
Methods |
Transthoracic echocardiograms of 100 patients with aortic stenosis and either atrial fibrillation (AF) or frequent ectopy (FE) were retrospectively reviewed. The aortic valve velocity time integral (VTIAV) and the left ventricular outflow tract VTI (VTILVOT) were measured by two methods: the standard method (averaging multiple beats) and the single cycle length method. The latter matches the R-R intervals for VTIAV and VTILVOT. Stroke volume, EOA, and Doppler velocity index were calculated by both methods in all patients. The single cycle length method was used for short and long R-R cycles in AF and for postectopic beats (long R-R cycles) in FE.
Results |
In AF, long R-R cycles resulted in larger stroke volumes (73 ± 21 vs 63 ± 18 mL; P ≤ .0001) but no difference in EOA (0.84 ± 0.27 vs 0.82 ± 0.27 cm2; P = .11), whereas short R-R cycles resulted in smaller stroke volumes (55 ± 18 vs 63 ± 18 mL, P ≤ .0001) but a larger EOA (0.86 ± 0.28 vs 0.82 ± 0.27 cm2; P = .01). In FE, the postectopic beat led to larger stroke volumes (96.1 ± 28 vs 78 ± 23 mL; P < .0001) and a larger EOA (0.99 ± 0.32 vs 0.94 ± 0.32 cm2; P = .0006) and Doppler velocity index (0.24 ± 0.07 vs 0.23 ± 0.07; P < .001).
Conclusions |
In AF patients, the single, long cycle length method of calculating EOA can be used instead of averaging multiple cardiac cycles. The single cycle length method used on a postextrasystolic beat results in a larger EOA than a normal sinus beat and may have utility in clinical decision-making.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Aortic EOA was measured by matching RR intervals in irregular heart rhythms. |
• | AF: Aortic EOA can be measured with a single cycle length, a long cycle is preferred. |
• | FE: The postectopic beat results in a higher transaortic gradient, SV, DVI, and EOA. |
Keywords : Aortic valve, Aortic stenosis, Echocardiography, Continuity equation, Atrial fibrillation, Transcatheter aortic valve replacement
Abbreviations : AF, AS, AV, DVI, EOA, FE, ICC, LVOT, R-R1, R-R2, TTE, VTIAV, VTILVOT
Plan
| Dr. Hahn is a speaker for Boston Scientific and Bayliss, a speaker and consultant for Abbott Vascular, Edwards Lifescience, Philips Healthcare, and Siemens Healthineers, a consultant for 3Mensio, Medtronic, and Navigate, and is the Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr. Khalique is a consultant for Edwards Life Sciences, JenaValve, and Cephea Valve Technologies. Dr Marcoff serves as a member of a cardiovascular core laboratory that has contracts with Edwards Lifesciences and Medtronic, for which he receives no direct compensation. The other authors reported no actual or potential conflicts of interest. |
Vol 32 - N° 3
P. 344-350 - mars 2019 Retour au numéro
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