Relationships between contour and/or contour/area ratio at Doppler and left ventricular hypertrophy in patients with significant aortic stenosis

Abstract

Planimetry of the stenotic flow areas using Doppler imaging of jet origin was performed, together with the measurement of their contour and a calculated contour/area (C/A) Doppler ratio, on 38 adult patients with significant aortic stenosis (0.27 to 0.85 cm 2). Echo measurements of left ventricular hypertrophy (LVH) were also performed to study the differences in LVH according to the areas, contours or C/A ratios. There were 10 areas below, and 28 over 0.5 cm 2. The latter group was subdivided according to a C/A < 0.8 ( n = 14), or 0.8 > ( n = 14). There was a wide scatter in values for LVH vs. areas, even in case of smaller areas. This led to lower mean values of LVH ( p < 0.001) in this group, and to a correlation coefficient at 0.18. The smallest areas were generally rounded and had a high C/A ratio. Contour was regular in half of areas over 0.5 cm 2. It increased less rapidly than areas increased, leading to a decreased C/A. The other half, of a similar range of sizes, had a markedly increased irregular contour, entailing a C/A > 0.8. The highest mean value in LVH was found in this subgroup. Correlation coefficients vs. LVH were 0.43 for contour, and 0.32 for C/A ratio. Diagnostic reliability of a C/A > 0.8 for an LVH > 150 g/ m 2 BSA ranged from 55 to 70%. In conclusion, the study suggests that contour length weighs on LVH development when stenoses are significant, and should be coupled with area measurements. Figures also suggest that other factors intervene, requiring further study.