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Comparison of invasive and non-invasive pressure gradients in aortic arch obstruction

Published online by Cambridge University Press:  20 January 2015

Bethany L. Wisotzkey ,
Christoph P. Hornik ,
Amanda S. Green  and
Piers C. A. Barker
Bethany L. Wisotzkey
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children’s Hospital, Seattle, Washington, United States of America
Christoph P. Hornik
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, United States of America
Amanda S. Green
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Miami Children’s Hospital, Miami, Florida, United States of America
Piers C. A. Barker*
Affiliation:
Department of Pediatrics, Division of Pediatric Cardiology, Duke University Medical Center, Durham, North Carolina, United States of America
*
Correspondence to: Dr P. C. A. Barker, MD, Duke Children’s Heart Program, CHC 1927A, Duke University Medical Center, Durham, NC 27710, United States of America. Tel: 919 681 2916; Fax: 919-681-5903; E-mail: piers.barker@dm.duke.edu
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Abstract

Background

Aortic arch obstruction can be evaluated by catheter peak-to-peak gradient or by Doppler peak instantaneous pressure gradient. Previous studies have shown moderate correlation in discrete coarctation, but few have assessed correlation in patients with more complex aortic reconstruction.

Methods

We carried out retrospective comparison of cardiac catheterisations and pre- and post-catheterisation echocardiograms in 60 patients with native/recurrent coarctation or aortic reconstruction. Aortic arch obstruction was defined as peak-to-peak gradient ⩾25 mmHg in patients with native/recurrent coarctation and ⩾10 mmHg in aortic reconstruction.

Results

Diastolic continuation of flow was not associated with aortic arch obstruction in either group. Doppler peak instantaneous pressure gradient, with and without the expanded Bernoulli equation, weakly correlated with peak-to-peak gradient even in patients with a normal cardiac index (r=0.36, p=0.016, and r=0.49, p=0.001, respectively). Receiver operating characteristic curve analysis identified an area under the curve of 0.61 for patients with all types of obstruction, with a cut-off point of 45 mmHg correctly classifying 64% of patients with arch obstruction (sensitivity 39%, specificity 89%). In patients with aortic arch reconstruction who had a cardiac index ⩾3 L/min/m2, a cut-off point of 23 mmHg correctly classified 69% of patients (71% sensitivity, 50% specificity) with an area under the curve of 0.82.

Conclusion

The non-invasive assessment of aortic obstruction remains challenging. The greatest correlation of Doppler indices was noted in patients with aortic reconstruction and a normal cardiac index.

Keywords

Arch reconstructioncoarctationDopplerpressure gradient
Type
Original Articles
Information
Cardiology in the Young , Volume 25 , Issue 7 , October 2015 , pp. 1348 - 1357
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Copyright
© Cambridge University Press 2015 

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