Ejection Fraction Velocity Ratio as an Indicator of Aortic Stenosis Severity

Authors

  • A.M. AL-Ghamdi M.D.,

    1. The Department of Medicine, Division of Cardiology, London Health Sciences Centre, Victoria Campus, University of Western Ontario, London, Ontario, Canada
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  • L.J. Melendez M.D., F.R.C.P.C.,

    1. The Department of Medicine, Division of Cardiology, London Health Sciences Centre, Victoria Campus, University of Western Ontario, London, Ontario, Canada
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    • * 

      Deceased.

  • D. Massel M.D., F.R.C.P.C.

    1. The Department of Medicine, Division of Cardiology, London Health Sciences Centre, Victoria Campus, University of Western Ontario, London, Ontario, Canada
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Address for correspondence and reprint requests: David Massel, M.D., F.R.C.P.C., The Department of Medicine, Division of Cardiology, London Health Sciences Centre, Room 205 Colborne Building, Victoria Campus, University of Western Ontario, 375 South St., London, Ontario, Canada, N6A 4G5. Fax: 519-667-6687; E-mail: dmassel@lhsc.on.ca

Abstract

Background: Despite the widespread use of the continuity equation in the estimation of aortic valve area (AVA) in patients with aortic stenosis, it is subject to errors, time consuming, and can be technically demanding. As such, simpler methods of assessing aortic stenosis severity have been pursued. Methods: The ejection fraction velocity ratio [EFVR = ejection fraction (%) / maximal aortic velocity (m/sec)] was compared to AVA determined with the continuity equation in 857 patients with aortic stenosis and varying degrees of LV systolic dysfunction. Severe aortic stenosis was defined as an AVA < 1.0 cm2. Results: There was good to excellent correlation between our index and aortic valve area (P < 0.001 for each ejection fraction subgroup). Receiver operating characteristic analysis showed that the EFVR functioned well with areas under the curve between 0.893 and 0.938. Conclusion: The EFVR is a simple noninvasive method for screening patients for an AVA of 1.0 cm2. It could be used as a screening test or in lieu of the continuity equation particularly when there is problematic measurement of either the LVOT diameter or velocity.

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