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Invasive versus non-invasive assessment of valvuloarterial impedance in severe aortic stenosis
- Source :
- Open Heart, Open Heart, Vol 7, Iss 1 (2020)
- Publication Year :
- 2020
- Publisher :
- BMJ Publishing Group, 2020.
-
Abstract
- BackgroundAs a measure of the global left ventricular afterload, valvuloarterial impedance (ZVA) can be estimated using transthoracic echocardiography (TTE) and invasive measuring methods. The objective of this study was to compare the performance of TTE in measuring ZVA with invasive haemodynamics, direct Fick and thermodilution (TD), in patients with severe aortic stenosis (AS).MethodsThis is a retrospective cohort study of 66 patients with severe AS who underwent TTE and bilateral heart catheterisation preaortic valve replacement. ZVA was calculated non-invasively from TTE and invasively using TD and Fick. The differences in measurements were estimated using a generalised estimating equation approach. The exchangeability of the measurements from different methods was evaluated under binary risk stratification rules.ResultsThe mean±SD ZVA by TTE was 4.6±1.4 vs 4.9±1.6 by TD vs 4.3±1.2 mm Hg m2/mL by Fick. From multivariate analyses, ZVA by TTE was 5.9% (95% CI −15.0 to 2.5) lower than by TD and 5.9% (95% CI −1.5 to 12.8) higher than by Fick. At the same time, ZVA by TD was 12.5% (3.0 to 22.9) higher than with Fick. Risk classifications for ZVA-based binary decision rules showed poor agreement between TTE and invasive methods (kappa ≤0.3).ConclusionsThe differences in ZVA estimates between TTE and invasive standards do not appear to exceed those between the standards. As such TTE-based estimates may be deemed acceptable as a clinical measure of global haemodynamic load. However, TTE-based and invasive measurements may not be interchangeable to identify patients at risk using binary classification rules based on ZVA.
- Subjects :
- Male
030213 general clinical medicine
medicine.medical_specialty
lcsh:Diseases of the circulatory (Cardiovascular) system
Cardiac Catheterization
medicine.medical_treatment
Thermodilution
Hemodynamics
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Valve replacement
Predictive Value of Tests
Internal medicine
medicine
Humans
In patient
Aged
Retrospective Studies
Left ventricular afterload
Valvuloarterial impedance
Aged, 80 and over
haemodynamics
business.industry
Non invasive
Reproducibility of Results
Retrospective cohort study
Aortic Valve Stenosis
aortic valve disease
medicine.disease
body regions
Stenosis
lcsh:RC666-701
Echocardiography
Valvular Heart Disease
Aortic Valve
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 20533624
- Volume :
- 7
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Open Heart
- Accession number :
- edsair.doi.dedup.....4f0b7523686915f263e34e1d89665532