Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography

Ring, Liam; Shah, Benoy N.; Harkness, Allan; Belham, Mark; Oxborough, David; Pearce, Keith; Rana, Bushra S.; Augustine, Daniel; Robinson, Shaun; Tribouilloy, Christophe

doi:10.1530/erp-20-0035

Cited by 37 publications

(39 citation statements)

References 159 publications

(304 reference statements)

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“…In addition, pressure drop estimation using Doppler echocardiography is highly user-dependent. If the angle of insonation is not fully aligned with the direction of blood flow, the maximum velocity will be missed [ 4 ]. Several non-invasive alternatives have been studied but are not yet applied clinically [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Blood speckle imaging compared with conventional Doppler ultrasound for transvalvular pressure drop estimation in an aortic flow phantom

Dockerill

Gill

Fernandes

et al. 2022

Cardiovasc Ultrasound

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Background Transvalvular pressure drops are assessed using Doppler echocardiography for the diagnosis of heart valve disease. However, this method is highly user-dependent and may overestimate transvalvular pressure drops by up to 54%. This work aimed to assess transvalvular pressure drops using velocity fields derived from blood speckle imaging (BSI), as a potential alternative to Doppler. Methods A silicone 3D-printed aortic valve model, segmented from a healthy CT scan, was placed within a silicone tube. A CardioFlow 5000MR flow pump was used to circulate blood mimicking fluid to create eight different stenotic conditions. Eight PendoTech pressure sensors were embedded along the tube wall to record ground-truth pressures (10 kHz). The simplified Bernoulli equation with measured probe angle correction was used to estimate pressure drop from maximum velocity values acquired across the valve using Doppler and BSI with a GE Vivid E95 ultrasound machine and 6S-D cardiac phased array transducer. Results There were no significant differences between pressure drops estimated by Doppler, BSI and ground-truth at the lowest stenotic condition (10.4 ± 1.76, 10.3 ± 1.63 vs. 10.5 ± 1.00 mmHg, respectively; p > 0.05). Significant differences were observed between the pressure drops estimated by the three methods at the greatest stenotic condition (26.4 ± 1.52, 14.5 ± 2.14 vs. 20.9 ± 1.92 mmHg for Doppler, BSI and ground-truth, respectively; p < 0.05). Across all conditions, Doppler overestimated pressure drop (Bias = 3.92 mmHg), while BSI underestimated pressure drop (Bias = -3.31 mmHg). Conclusions BSI accurately estimated pressure drops only up to 10.5 mmHg in controlled phantom conditions of low stenotic burden. Doppler overestimated pressure drops of 20.9 mmHg. Although BSI offers a number of theoretical advantages to conventional Doppler echocardiography, further refinements and clinical studies are required with BSI before it can be used to improve transvalvular pressure drop estimation in the clinical evaluation of aortic stenosis.

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Section: Introductionmentioning

confidence: 99%

Blood speckle imaging compared with conventional Doppler ultrasound for transvalvular pressure drop estimation in an aortic flow phantom

Dockerill

Gill

Fernandes

et al. 2022

Cardiovasc Ultrasound

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“…These findings support the observation that the overestimation of pressure drop by Doppler echocardiography is more pronounced at higher flow rates. The simplified Bernoulli formulation is accurate for uniform Doppler velocity profiles, observed at low flow velocities [4]. As flow rate and pressure drop increased in our experiments, the flow profiles became more heterogenous, explaining why Doppler is less accurate under these higher flow regimes (Fig.…”

Section: Pressure Drop Estimationmentioning

confidence: 68%

“…(2017), where pressure drop values obtained using the Simplified Bernoulli formulation were shown to overestimate the true pressure drop by 54% [4].…”

Section: Pressure Drop Estimationmentioning

confidence: 99%

“…Taking a single peak velocity event ignores the complex haemodynamics of blood flow across the valve, where the full velocity profile at the point of maximum flow constriction is needed to estimate the actual pressure drop. In addition, if the angle of insonation is not fully aligned with the direction of blood flow, the maximum velocity will be missed [4]. Several noninvasive alternatives have been studied but are not yet applied clinically [5].…”

Section: Introductionmentioning

confidence: 99%

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Blood Speckle Imaging Compared with Conventional Doppler Ultrasound for Transvalvular Pressure Drop Estimation in an Aortic Flow Phantom

Dockerill

Gill

Fernandes

et al. 2022

Preprint

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Background Transvalvular pressure drops are assessed using Doppler echocardiography for the diagnosis of heart valve disease. However, this method is highly user-dependent and may overestimate transvalvular pressure drops by up to 54%. This work aimed to assess transvalvular pressure drops using velocity fields derived from blood speckle imaging (BSI), as a potential alternative to Doppler. Methods A silicone 3D-printed aortic valve model, segmented from a healthy CT scan, was placed within a silicone tube. A CardioFlow 5000MR flow pump was used to circulate blood mimicking fluid to create eight different stenotic conditions (transvalvular flow velocities between 1.6 and 2.4 m/s and pressure drops between 9.7 and 22.7 mmHg). Eight PendoTech pressure sensors were embedded along the tube wall to record ground-truth pressures (10 KHz). The Bernoulli equation with measured probe angle correction was used to estimate pressure drop from maximum velocity values acquired across the valve using Doppler and BSI with a GE Vivid E95 ultrasound machine and 6S-D cardiac phased array transducer. Results There were no significant differences between pressure drops estimated by Doppler, BSI and ground-truth at the lowest stenotic condition (10.4 ± 1.76, 10.3 ± 1.63 vs. 10.7 ± 1.12 mmHg, respectively; p>0.05). Significant differences were observed between the pressure drops estimated by the three methods at the greatest stenotic condition (26.4 ± 1.52, 14.5 ± 2.14 vs. 20.1 ± 1.78 mmHg for Doppler, BSI and ground-truth, respectively; p<0.05). Across all conditions, Doppler overestimated pressure drop (Bias = 3.54 mmHg), while BSI underestimated pressure drop (Bias = -3.68 mmHg). Conclusions BSI accurately estimated pressure drops only up to 10.7 mmHg in controlled phantom conditions of low stenotic burden. Although BSI offers a number of theoretical advantages to conventional Doppler echocardiography, further refinements and clinical studies are required with BSI before it can be used to improve transvalvular pressure drop estimation in the clinical evaluation of aortic stenosis.

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“…e assessment of the aortic stenosis severity is conventionally performed with echocardiographic two-dimensional (2D) and Doppler assessment, with the main parameters being the peak jet velocity, the transvalvular mean gradient, and the valve area (as obtained by the continuity equation), while the ventricular function is routinely conducted with the echocardiographic assessment of the ejection fraction [5,6]. Left ventricular ejection fraction (LVEF) has been traditionally one of the important prognostic markers of the disease, as patients with early left ventricular decompensation as evidenced by EF <60% have an increased risk of mortality, even after valve replacement [7] leading the National Institute for Health and Care Excellence (NICE) in the UK to recommend consideration of intervention when the LVEF <60% when the decline is attributed to the AS in their initial guidance in March 2021 [8].…”

Section: Aortic Stenosismentioning

confidence: 99%

Valvular Cardiomyopathy: The Value of Cardiovascular Magnetic Resonance Imaging

Tsampasian

Hothi

Ravindrarajah

et al. 2022

Cardiology Research and Practice

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Cardiovascular magnetic resonance (CMR) imaging has had a vast impact on the understanding of a wide range of disease processes and pathophysiological mechanisms. More recently, it has contributed significantly to the diagnosis and risk stratification of patients with valvular heart disease. With its increasing use, CMR allows for a detailed, reproducible, qualitative, and quantitative evaluation of left ventricular volumes and mass, thereby enabling assessment of the haemodynamic impact of a valvular lesion upon the myocardium. Postprocessing of the routinely acquired images with feature tracking CMR methodology can give invaluable information about myocardial deformation and strain parameters that suggest subclinical ventricular impairment that remains undetected by conventional measures such as the ejection fraction (EF). T1 mapping and late gadolinium enhancement (LGE) imaging provide deep myocardial tissue characterisation that is changing the approach towards risk stratification of patients as an increasing body of evidence suggests that the presence of fibrosis is related to adverse events and prognosis. This review summarises the current evidence regarding the utility of CMR in the left ventricular assessment of patients with aortic stenosis or mitral regurgitation and its value in diagnosis, risk stratification, and management.

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Echocardiographic assessment of aortic stenosis: a practical guideline from the British Society of Echocardiography

Cited by 37 publications

References 159 publications

Blood speckle imaging compared with conventional Doppler ultrasound for transvalvular pressure drop estimation in an aortic flow phantom

Blood speckle imaging compared with conventional Doppler ultrasound for transvalvular pressure drop estimation in an aortic flow phantom

Blood Speckle Imaging Compared with Conventional Doppler Ultrasound for Transvalvular Pressure Drop Estimation in an Aortic Flow Phantom

Valvular Cardiomyopathy: The Value of Cardiovascular Magnetic Resonance Imaging

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