EFFECT OF DOPPLER-ECHOCARDIOGRAPHY ON UTILIZATION OF HEMODYNAMIC CARDIAC-CATHETERIZATION IN THE PREOPERATIVE EVALUATION OF AORTIC-STENOSIS

Objective: To examine the use of Doppler echocardiography in preoperat ive assessment of aortic stenosis and to determine its effect on subse quent use of hemodynamic cardiac catheterization. Material and Methods : We retrospectively reviewed a consecutive series of 574 adult patien ts who underwent aortic valve replacement for aortic stenosis between 1990 and 1992 at our institution. The use of Doppler echocardiography and cardiac catheterization and the predictive factors for use of hemo dynamic catheterization were analyzed. Results: After Doppler echocard iography in 423 patients, invasive hemodynamic assessment of the sever ity of aortic stenosis was performed in only 42% (179 patients). The u se of cardiac catheterization declined over time (54% in 1990, 40% in 1991, and 35% in 1992) (P = 0.003), whereas no significant change in t he baseline clinical characteristics of the population or in severity of stenosis as determined by Doppler echocardiography occurred during that time. Multivariate analysis identified the following variables as independent predictors of use of cardiac catheterization after Dopple r echocardiography: clinically not severe aortic stenosis, mean gradie nt of less than 50 mm Hg determined by Doppler echocardiography. Doppl er-determined aortic valve area of more than 0.8 cm(2) or not calculat ed, attending cardiologist not specialized in echocardiography, and ea rlier year of assessment. Conclusion: After Doppler echocardiography, less than 50% of our patients undergoing aortic valve replacement for aortic stenosis have cardiac catheterization preoperatively. The use o f cardiac catheterization after Doppler echocardiography-thus, duplica tion of hemodynamic assessment-declined significantly over time during the study period. Decline in the use of catheterization is related to the degree of diagnostic certainty provided by Doppler echocardiograp hy and to the level of familiarity of the attending cardiologist with the technique.