Echocardiographic left ventricular dimensions in pressure and volume overload. Their use in assessing aortic stenosis.

Abstract

Left ventricular 'relative wall thickness', determinedfrom the ratio between echocardiographic measurements of end-systolic wall thickness and cavity transverse dimension, was related to peak systolic intraventricular pressure in I5 normal subjects, in I5 patients with left ventricular volume or pressure overload without aortic stenosis, and in 23 patients with aortic stenosis. All these patients had a mean rate of circumferential fibre shortening greater than I.O circumference per second and were regarded as having good ventricular function. Relative wall thickness was found to be normal in cases of volume overload and to be increased in pressure overload, being proportional to the systolic intraventricular pressure. Values for the ratio of systolic intraventricular pressure to relative wall thickness in the normal subjects and patients without aortic stenosis were similar (mean 30+ 2.5). Based on this relation, estimates ofpeak systolic intraventricular pressure were made in the cases of aortic stenosis using theformula: systolic intraventricular pressure (kPa) = 30 x wall thickness . transverse dimension. Peak systolic aortic valve gradients derived by subtracting brachial artery systolic pressure, measured by sphygmomanometer, from the echocardiographic estimates of intraventricular pressure comparedfavourably with the gradients measured at left heart catheterization (r=o.87, P< o.OOi).Aortic valve orifice areas, derived from echocardiographic estimates of stroke volume, ejection time, and valve gradient, rangedfrom 0.21 to 3.16 cm2 and appeared to correlate with the severity of aortic stenosis. All patients with aortic stenosis, with or without coexistent mild aortic regurgitation, who were recommended for aortic valve surgery, had estimated valve orifice areas of less than o.8 cm2.A further io patients with pressure or volume overload had mean rates of circumferentialfibre shortening of less than I.o circumference per second and were regarded as having poor ventricular function. In these cases values for relative wall thickness were lower than in those with good ventricular function and were not proportional to systolic intraventricular pressure.In patients with good left ventricular function systolic intraventricular pressure is proportional to, and can be estimatedfrom, echocardiographic measurement of relative wall thickness.

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Assessment of chronic aortic valve disease in adults

“…In the presence of normal ventricular function, a formula has also been worked out to calculate left ventricular systolic pressure by echocardiography and hence provide a non-invasive means of investigating the severity of outflow tract obstruction (Bennett, Evans and Raj, 1975;Schwartz et al, 1978).…”