Reliable estimation of peak left ventricular systolic pressure by M-mode echographic-determined end-diastolic relative wall thickness: identification of severe valvular aortic stenosis in adult patients.

Overview

In compensated hearts, left ventricular systolic pressure (LVSP) can be estimated from the ratio of LV wall thickness to chamber radius (RWT). To determine the clinical value of such estimates, we examined echocardiography RWT in an unscreened series of 81 individuals with aortic valve disease, hypertension, or normal hearts. Despite the presence, in many subjects, of symptoms of congestive heart failure, reduced ejection fraction, or coronary disease, end-diastolic RWT (RWTD) correlated well with peak LVSP (r = 0.77); 45 of 55 patients with LVSP greater than or equal to 140 mm Hg had RWTD greater than or equal to 0.45, while 26 of 26 with LVSP less than 140 mm Hg had lower values (p less than 0.005). RWTD was greater than or equal to 0.50 in 30 of 34 patients with LVSP greater than or equal to 180 mm Hg and in 6 of 21 with LVSP 140 to 180 mm Hg. RWTD correctly estimated LVSP range in 26 of 27 severe aortic stenosis (AS) patients and, combined with echocardiographic aortic valve calcification, correctly recognized the presence or absence of severe AS in 99% of the series. The RWTD for any given LVSP was higher in patients on antihypertensive treatment and lower in patients with severe aortic regurgitation. In contrast to series based on patients with normal LV function, end-systolic RWT correlated poorly with LVSP.