Validation at the ejection fraction-velocity ratio: A new simplified "function-corrected" index for assessing aortic stenosis severity

A new echocardiographic method for the evaluation of aortic stenosis (AS) s everity has recently been introduced: the fractional shortening-velocity ra tio (FSVR = fractional shortening/4 Vmax(2)). An important advantage of the method is the possibility of avoiding the difficulties related to the meas urement of left ventricular outflow tract in calcific AS for assessing the continuity equation. FSVR, however, also shows some significant limitations especially in patients with regional wall motion abnormalities and conduct ion defects. To overcome this problem, we developed a new index: the ejecti on fraction-velocity ratio (EFVR ejection fraction/4 Vmax(2)), where percen t ejection fraction and Vmax have been obtained with an apical echocardiogr aphic approach. In 343 consecutive patients with AS, aortic valve area was measured by cardiac catheterization (Gorlin), whereas FSVR and EFVR were ca lculated by echo-Doppler examination performed within 24 hours. Mean valve area was 0.70 +/- 0.30 cm(2), mean EFVR was 0.78 +/- 0.41, and mean FSVR wa s 0.45 +/- 0.26, The linear correlation area-EFVR was highly significant (r = 0.88), Correlation valve area-FSVR was also significant (r = 0.82). EFVR allowed identification of patients with severe AS (area less than or equal to 0.8 cm(2)) with good sensitivity (88%) and specificity (85%), whereas F SVR demonstrated sensitivity of 88% and specificity of 73%, Thus, the EFVR, a very simple and not time-consuming index, is strongly related to aortic valve area in patients with AS. It allows identification of patients with s evere AS with good sensitivity and specificity (better than FSVR), The EFVR , taking into consideration both ejection fraction and transvalvular pressu re gradient, may be very useful in the evaluation of patients with AS and l eft ventricular dysfunction. (C)2000 by Excerpta Medica, Inc.