De waarde van Doppler-echocardiografie bij de behandeling van patiënten met aorta- en mitralisklepgebreken

To compare management recommendations based on Doppler echocardiographic examination and cardiac catheterization.

Setting

Academisch Medisch Centrum, Amsterdam.

Design

Prospective study (1988).

Patients and methods

Management recommendations were provided independently after both Doppler echocardiography and cardiac catheterization by different and blinded investigators in 100 consecutive patients with aortic or mitral valvular heart disease. Criteria for severe (clinically significant) and moderate to mild (insignificant) valvular lesions and management recommendations were agreed on in advance.

Results

There was disagreement on the severity of aortic stenosis in one of 38 patients with severe aortic stenosis at Doppler echocardiography, which resulted in a different management recommendation. Mitral stenosis was severe (valve area = < 1 cm²) at Doppler echocardiography but not at cardiac catheterization in five out of 14 patients. Because a pulmonary artery pressure rise during exercise at cardiac catheterization also suggested severe obstruction, management recommendations were similar.

There was a potentially significant disagreement on the severity of aortic regurgitation in nine out of 76 patients and of mitral regurgitation in 14 of 90 patients; however, this did not lead to different management recommendations because co-existent valvular lesions or an impaired ventricular function mainly determined the ultimate management decision. Doppler echocardiography was non-conclusive for clinical decision making in 15 of the study population because of uncertainty about the severity of mitral regurgitation or aortic regurgitation or because of problems in assessing the degree of left ventricular dysfunction in patients with severe regurgitation. Unsuspected coronary artery disease (> 50 luminal narrowing) was present in 25 of patients with isolated mitral valve disease, in only 6 of patients with isolated aortic valve disease and in 14 of patients with combined aortic and mitral valve disease.

Conclusion

Doppler echocardiography can be applied for management recocommendations in aortic or mitral stenosis. Moreover, it can be used in combined aortic valve disease or combined mitral valve disease, if valvular stenosis is severe. Doppler echocardiography assessment of the haemodynamic importance of isolated aortic or mitral regurgitation (using color Doppler jet dimensions), is less reliable.

The decision to perform selective coronary angiography should be individualied.