P294Blood pressure impact on aortic stenosis severity evaluation in everyday clinical practice


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Abstract

Purpose: Aortic stenosis (AS) is frequently associated with hypertension but its real impact on AS severity evaluation is not clear. However guidelines recommends reporting blood pressure to allow comparison between serial echocardiographic studies. The aim of this study was to assess the impact of blood pressure on parameters of AS severity during a single echocardiography.Methods: Brachial blood pressure was measured at the beginning and at the end of a transthoracic echocardiography for 30 consecutive patients referred for aortic stenosis evaluation. Aortic continuous-wave and pulsed-wave Doppler were acquired at both time in order to measure off-line maximum velocity, mean gradient and valve area.Results: Systolic blood pressure significatively decreased between the beginning and the end of the examination (p<0.001). Mean transvalvular gradient, maximum velocity and stroke work loss increased (p<0.01). On the contrary, effective orifice area decreased (p<0.001). Cardiac output did not change. Systolic blood pressure was correlated with effective orifice area (r=0.51, p<0.01) and was inversely correlated with maximum velocity (r=-0.47, p<0.05). Seven patients crossed a threshold value which made AS change of classification : 3 patients turned from sclerosis to mild AS, 1 from mild to moderate AS and 3 from moderate to severe AS. No patient crossed a threshold value making AS appearing less severe.Conclusion: Blood pressure variation during echocardiographic examination has an impact on AS severity, which appears to be more severe at the end of the examination. One should take care to have optimal blood pressure conditions when acquiring doppler measurements for evaluation of AS severity, thus allowing a more reliable assessment.

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