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SEAS: Pressure recovery adjustment critical in determining aortic valve area
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An inaccurate assessment of the severity of aortic stenosis in patients with asymptomatic aortic stenosis may be the result of not performing pressure recovery adjustment, study findings suggest.
According to researchers, this was the first study to investigate the incidence and magnitude of pressure recovery in a large cohort of asymptomatic aortic stenosis patients prospectively recruited. The SEAS study consisted of 1,563 patients for whom aortic valve area and aortic diameter at the sinotubular junction was measurable on the baseline echocardiogram. Researchers measured the inner aortic diameter at annulus, sinus, sinotubular junction and supracoronary level.
Pressure recovery grew with increasing peak transaortic velocity. Overestimation of aortic stenosis severity by unadjusted aortic valve area index was largest in the lowest tertile and when pressure recovery was assessed at the sinotubular junction. In multiple regression analysis (multiple R²=0.18; P<.001), a larger difference between aortic valve area index and energy loss index correlated with lower peak transaortic velocity independent of higher left ventricular ejection fraction, male sex, younger age and smaller aortic sinus diameter. The researchers reported that 47.5% of patients classified by aortic valve area index as having severe aortic stenosis were reclassified to nonsevere following the incorporation of pressure recovery.
“The findings demonstrate that clinically important pressure recovery is present in a significant number of asymptomatic patients with aortic stenosis and a transvalvular velocity of 2.5 to 4.0 m/s,” the researchers wrote.
In an accompanying editorial comment, Shahbudin H. Rahimtoola, MD, of the Los Angeles County and University of Southern California Medical Center, said for accurate assessment of aortic stenosis severity by echocardiography/Doppler, the aortic valve area must be adjusted for energy recovery and calculated as energy loss index.
“The investigators’ conclusion that evaluation of energy/pressure recovery is important for proper assessment of severity of aortic stenosis needs to be emphasized,” Rahimtoola wrote.
Bahlmann E. J Am Coll Cardiol Img. 2010;3:555-562.