Noninvasive estimation of the left ventricular pressure waveform throughout ejection in young patients with aortic stenosis

Abstract

Validation of a totally noninvasive method for estimating instantaneous left ventricular pressure and constructing a pressure waveform throughout ejection in patients with aortic stenosis is reported. In 20 patients (aged 8.75 ± 10 years) with congenital aortic stenosis (measured peak left ventricular pressure 120 to 260 mm Hg; transvalvular gradient 18 to 165 mm Hg), transaortic valve continuous wave Doppler ultrasound, indirect carotid pulse tracing, peripheral blood pressure and measured left ventricular pressure were recorded simultaneously at cardiac catheterization. Data were entered into a microcomputer using a digitizing tablet and the instantaneous Doppler gradient was calculated and added to instantaneous aortic pressure, derived from the time-corrected and calibrated carotid pulse tracing, to estimate instantaneous left ventricular pressure.Estimated left ventricular pressure waveforms reproduced measured left ventricular pressure closely. The mean error at peak left ventricular pressure was 0.2 ± 4.8 mm Hg (r = 0.98, p = 0.001). The average error throughout ejection was 0.9 ± 5.1 mm Hg. The error of estimated pressure was not related to age or the severity of aortic stenosis. The Doppler peak instantaneous gradient was observed to correlate closely (r = 0.97, p = 0.001) with peak to peak gradient.With this technique, the left ventricular pressure wave-form throughout ejection can be accurately estimated non-invasively in patients with aortic stenosis. This methodology enables determination of mean, total and instantaneous systolic left ventricular pressure.