Circulation, Vol 89, 827-835, Copyright © 1994 by American Heart Association
IG Burwash, DD Thomas, M Sadahiro, AS Pearlman, ED Verrier, R Thomas, CD Kraft and CM Otto
BACKGROUND: Valve areas derived by the Gorlin formula have been observed to
vary with transvalvular volume flow rate. Continuity equation valve areas
calculated from Doppler-echo data have become a widely used alternate index
of stenosis severity, but it is unclear whether continuity equation valve
areas also vary with volume flow rate. This study was designed to
investigate the effects of changing transvalvular volume flow rate on
aortic valve areas calculated using both the Gorlin formula and the
continuity equation in a model of chronic valvular aortic stenosis. METHODS
AND RESULTS: Using a canine model of chronic valvular aortic stenosis in
which anatomy and hemodynamics are similar to those of degenerative aortic
stenosis, each subject (n = 8) underwent three studies at 2-week intervals.
In each study, transvalvular volume flow rates were altered with saline or
dobutamine infusion (mean, 10.3 +/- 5.1 flow rates per study). Simultaneous
measurements were made of hemodynamics using micromanometer-tipped
catheters, of ascending aortic instantaneous volume flow rate using a
transit-time flowmeter, and of left ventricular outflow and aortic jet
velocity curves using Doppler echocardiography. Valve areas were calculated
from the invasive data by the Gorlin equation and from the Doppler-echo
data by the continuity equation. In the 24 studies, mean transit-time
transvalvular volume flow rate ranged from 80 +/- 33 to 153 +/- 49 mL/min
(P < .0001). Comparing minimum to maximum mean volume flow rates, the
Gorlin valve area changed from 0.54 +/- 0.22 cm2 to 0.68 +/- 0.21 cm2 (P
< .0001), and the continuity equation valve area changed from 0.57 +/-
0.18 cm2 to 0.70 +/- 0.20 cm2 (P < .0001). A strong linear relation was
observed between Gorlin valve area and mean transit-time volume flow rate
for each study (median, r = .88), but the slope of this relation varied
between studies. The Doppler-echo continuity equation valve area had a
weaker linear relation with transit-time volume flow rate for each study
(median, r = .51). CONCLUSIONS: In this model of chronic valvular aortic
stenosis, both Gorlin and continuity equation valve areas were
flow-dependent indices of stenosis severity and demonstrated linear
relations with transvalvular volume flow rate. The changes in calculated
valve area that occur with changes in transvalvular volume flow should be
considered when measures of valve area are used to assess the hemodynamic
severity of valvular aortic stenosis.
ARTICLES
Dependence of Gorlin formula and continuity equation valve areas on transvalvular volume flow rate in valvular aortic stenosis
Department of Medicine, University of Washington, Seattle 98195.
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