Comparison of cardiac catheterization and Doppler echocardiography in the decision to operate in aortic and mitral valve disease

Abstract

Clinical decisions utilizing either Doppler echocardiographic or cardiac catheterization data were compared in adult patients with isolated or combined aortic and mitral valve disease. A clinical decision to operate, not operate or remain uncertain was made by experienced cardiologists given either Doppler echocardiographic or cardiac catheterization data. A prospective evaluation was performed on 189 consecutive patients (mean age 67 years) with valvular heart disease who were being considered for surgical treatment on the basis of clinical information. All patients underwent cardiac catheterization and detailed Doppler echocardiographic examination. Three sets of two cardiologist decision makers who did not know patient identity were given clinical information in combination with either Doppler echocardiographic or cardiac catheterization data. The combination of Doppler echocardiographic and clinical data was considered inadequate for clinical decision making in 21% of patients with aortic and 5% of patients with mitral valve disease. The combination of cardiac catheterization and clinical data was considered inadequate in 2% of patients with aortic and 2% of patients with mitral valve disease. Among the remaining patients, the cardiologists using echocardiographic or angiographic data were in agreement on the decision to operate or not operate in 113 (76% overall). When the data were analyzed by specific valve lesion, decisions based on Doppler echocardiography or catheterization were in agreement in 92%, 90%, 83% and 69%, respectively, of patients with aortic regurgitation, mitral stenosis, aortic stenosis and mitral regurgitation. Differences in cardiac output determination, estimation of valvular regurgitation and information concerning coronary anatomy were the main reasons for different clinical management decisions. These results suggest that for most adult patients with aortic or mitral valve disease, alone or in combination, Doppler echocardiographic data enable the clinician to make the same decision reached with catheterization data.

Echocardiographic Evaluation of Valvular Stenosis: The Gold Standard for the Next Millennium?

“…20 There will always be some disagreement between these two techniques because of nonsimultaneity and because they measure hemodynamics in different ways. A recent prospective study compared clinical decisions based on echocardiography to those based on cardiac catheterization in patients with aortic and mitral stenosis.…”

“…Doppler echocardiographic data enabled clinicians to make the same decision as would have been reached with catheterization data in all but 10%-17%. 20 There will always be some disagreement between these two techniques because of nonsimultaneity and because they measure hemodynamics in different ways. Also, there are limitations of echocardiography in certain clinical settings, 21 and limitations of invasive hemodynamics in others.…”

New quantitative three-dimensional echocardiographic indices of mitral valve stenosis

“…In 18 patients (40%), aortic insufficiency was present (16 patients grade 1+, 1 patient grade 2+, and 1 patient grade 3+). The grade of regurgitation was assessed by color flow mapping described elsewhere [2,3]. The baseline characteristics are listed in Table 1.…”

Not all right-sided hearts are the same—the importance of identifying the correct diagnosis

“…This case exemplifies the need for detailed and objective assessment of the degree of shunting, in order to better guide therapy. Experts suggest using Doppler echocardiography (17) to determine pulmonary and systemic flow ratios (Qp:Qs) estimating left to right heart shunt. A ratio of 1:1 indicates equal volumes of blood travel through the lungs (Qp) and the systemic circulation (Qs) (18).…”