[Clinical significance of Doppler echocardiographic determination of the severity of aortic valve stenoses].

The purpose of the study was to evaluate the clinical significance of Doppler echocardiography in the determination of the severity of aortic stenosis, in particular, to determine to what extent a therapeutic decision in the individual patient is possible solely on the basis of noninvasive investigations. Forty consecutive patients (mean age 53 +/- 13 years, 58% males) with suspected aortic valve disease of purely or mainly stenotic nature, were examined by two-dimensional echocardiography and continuous-wave Doppler echocardiography on average 48 h before cardiac catheterization. An adequate Doppler registration was obtained in 93% (37/40). In 59% the right sternal border proved to be the best window. The gradient determined in the Doppler examination correlated well with the maximum catheter gradient (r = 0.95; SYX +/- 6.2 mm Hg; p less than 0.0005) and with the peak-to-peak catheter gradient (r = 0.93; SYX +/- 6.0 mm Hg; p less than 0.0005). However, in the individual case, clinical assessment on the basis of the Doppler gradient alone proved to be misleading. This was the case in early systolic gradients (aortic incompetence, high cardiac output) or in pronounced left ventricular dysfunction. However, additional consideration of the ratio time to peak velocity (Vmax)/left ventricular ejection time (LVET) (criterion for operation greater than 0.35) and of the echocardiographically determined ejection fraction, enabled us to make the same therapeutic decision in all 37 patients (17 conservative, 20 operative) as that made following the result of cardiac catheterization.(ABSTRACT TRUNCATED AT 250 WORDS)