End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography: a new predictor of the aortic regurgitant fraction.

Tribouilloy, Christophe; Avinée, P; Shen, Wei Feng; Rey, Jean‐Luc; Slama, Michel; Lesbre, J P

doi:10.1136/hrt.65.1.37

Cited by 71 publications

(33 citation statements)

References 9 publications

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“…Furthermore, none of the included subjects had holo-diastolic reversal, with an extremely high reverse flow in end diastole (Table), which is strongly suggestive of aortic regurgitation. 19,33 Despite the established absence of aortic regurgitation, the presence of aortic flow reversal was confirmed in 100% of our subjects, suggesting that other mechanisms rather than aortic valve disorder are primarily involved in the generation of aortic reverse flow. We found that the aortic reverse/forward flow ratio was independently associated with aortic characteristic impedance and PWV (Figure 2; Tables S1 and S2).…”

Section: Discussionmentioning

confidence: 99%

Aortic Stiffness Determines Diastolic Blood Flow Reversal in the Descending Thoracic Aorta

2013

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Abstract-Aortic stiffening often precedes cardiovascular diseases, including stroke, but the underlying pathophysiological mechanisms remain obscure. We hypothesized that such abnormalities could be attributable to altered central blood flow dynamics. In 296 patients with uncomplicated hypertension, Doppler velocity pulse waveforms were recorded at the proximal descending aorta and carotid artery to calculate the reverse/forward flow ratio and diastolic/systolic flow index, respectively. Tonometric waveforms were recorded on the radial artery to estimate aortic pressure and characteristic impedance (Z 0 ) and to determine carotid-femoral (aortic) and carotid-radial (peripheral) pulse wave velocities. In all subjects, the aortic flow waveform was bidirectional, comprising systolic forward and diastolic reverse flows. The aortic reverse/forward flow ratio (35±10%) was positively associated with parameters of aortic stiffness (including pulse wave velocity, Z 0 , and aortic/peripheral pulse wave velocity ratio), independent of age, body mass index, aortic diameter, and aortic pressure. The carotid flow waveform was unidirectional and bimodal with systolic and diastolic maximal peaks. There was a positive relationship between the carotid diastolic/systolic flow index (28±9%) and aortic reverse/ forward flow ratio, which remained significant after adjustment for aortic stiffness and other related parameters. The Bland-Altman plots showed a close time correspondence between aortic reverse and carotid diastolic flow peaks. In conclusion, aortic stiffness determines the extent of flow reversal from the descending aorta to the aortic arch, which contributes to the diastolic antegrade flow into the carotid artery. This hemodynamic relationship constitutes a potential mechanism linking increased aortic stiffness, altered flow dynamics, and increased stroke risk in hypertension.

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Section: Discussionmentioning

confidence: 99%

Aortic Stiffness Determines Diastolic Blood Flow Reversal in the Descending Thoracic Aorta

2013

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“…Aortic regurgitation was assessed echocardiographically as trivial, mild (regurgitation without a reverse diastolic flow in the aortic arch), moderate (reverse diastolic flow in the aortic arch but not in the abdominal aorta), or severe (reverse diastolic flow in the abdominal aorta). 19 If applicable, aortic regurgitation shortly before subsequent aortic valve surgery also was evaluated.…”

Section: Aortic Regurgitationmentioning

confidence: 99%

Aortic Valvuloplasty in Pediatric Patients Substantially Postpones the Need for Aortic Valve Surgery

et al. 2008

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Background-Aortic valvuloplasty (AoVP) is an established procedure regarded as a valid alternative for surgical management of congenital aortic valve stenosis. However, its long-term efficacy in preventing or postponing aortic valve surgery remains uncertain for the individual patient. Therefore, the aim of this study was to study the long-term results of AoVP in pediatric patients and its efficacy in preventing or postponing aortic valve surgery. Methods and Results-We reviewed up to 17.5 years of follow-up data of all 188 patients who received AoVP at the Deutsches Herzzentrum München. The patients were divided into those Ͻ1 month of age (group Ͻ1 month; nϭ68) and those Ն1 month of age (group Ն1 month; nϭ120) at the time of AoVP. After the first and second AoVP, moderate and severe aortic regurgitation developed in 29% and 14%, respectively, of the patients in group Ͻ1 month and in 19% and 29%, respectively, of the patients in group Ն1 month. Survival after 10 years free from aortic valve surgery was 59% (95% confidence interval, 45 to 73) in group Ͻ1 month and 70% (95% confidence interval, 59 to 81) in group Ն1 month. Conclusions-This

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“…According to Pearson correlation analysis their correlation was very significant (r=0.69, p<0.001). Previous studies showed that forward and reverse flow profiles in the ascending aorta can be irregular and unreliable (12,13). However, there are other studies showing that descending aorta velocity profile was more reliable (14,15).…”

Section: Discussionmentioning

confidence: 74%

“…Previous studies have reported a good correlation between severity of aortic regurgitation and Doppler assessment of flow velocity at the end of diastole in the descending aorta just beneath the aortic isthmus (11)(12)(13)(14). Also descending aorta velocity profile was more reliable than ascending aorta (15).…”

Section: Introductionmentioning

confidence: 81%

Assessment of the severity of aortic regurgitation with pulsed wave Doppler velocity profile in the descending aorta

Kalaycı¹,

Kalaycı²,

Bayır³

et al. 2014

Anadolu Kardiyol Derg

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Objective: The quantitative parameters which are used to assess the severity of aortic regurgitation (AR) provide the most accurate information whereas these parameters are difficult and time-consuming. The aim of this study was to get a practical parameter to use in daily practice for assessing the severity of aortic regurgitation. Methods: The study was an observational cohort study on diagnostic accuracy of severity of aortic regurgitation. Thirty-seven patients with aortic regurgitation determined by quantitative parameters (18 patients with severe aortic regurgitation and 19 patients with moderate aortic regurgitation) were included in this study. Each patient's diastolic flow pattern in the descending aorta was examined by pulsed wave Doppler. Systolic and diastolic flow time-velocity integral (TVI), TVI time, systolic and diastolic TVI ratio in the descending aorta were evaluated. In addition to these parameters, dP/dt, peak acceleration time and end-diastolic flow velocity in the diastolic flow were determined. We investigated whether there a significant difference between two groups or not. Receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off values of echocardiographic parameters which were used to identify the severity of aortic regurgitation. Results: The study population was composed of 16 female and 21 male patients. Their mean age was 46.5 years. The mean diastolic flow TVI of patients who had moderate and severe aortic regurgitation was found 10.1 cm and 18.6 cm, respectively (p<0.001). In the ROC curve analysis, the values of diastolic flow TVI above 13.5 cm was found to have 83% sensitivity and 90% specifity to predict the severity of aortic regurgitation (AUC: 0.91, 95% CI 0.80-1.0, p<0.001). Also we investigated the other parameters like systolic flow TVI, the ratio of systolic and diastolic flow TVI, mean diastolic flow time, mean systolic flow time, the ratio of systolic and diastolic flow time, end-diastolic velocity, peak acceleration time, dP/ dt values in evaluation of diastolic flow in the descending aorta. These parameters were found statistically significant in assessing the severity of aortic regurgitation but their statistical power was weak. Conclusion: TVI of diastolic flow which is measured with pulsed wave Doppler in descending aorta could be a practical parameter in assessing the severity of aortic regurgitation. (Anadolu Kardiyol Derg 2014; 14: 427-33)

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End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography: a new predictor of the aortic regurgitant fraction.

Cited by 71 publications

References 9 publications

Aortic Stiffness Determines Diastolic Blood Flow Reversal in the Descending Thoracic Aorta

Aortic Stiffness Determines Diastolic Blood Flow Reversal in the Descending Thoracic Aorta

Aortic Valvuloplasty in Pediatric Patients Substantially Postpones the Need for Aortic Valve Surgery

Assessment of the severity of aortic regurgitation with pulsed wave Doppler velocity profile in the descending aorta

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