ArticleEcho research and practice2025
Continuous wave doppler pre-attenuation velocity envelope: a promising tool for the echocardiographic assessment of aortic stenosis.
Article in Echo research and practice, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn this study, we evaluated the utility of the continuous wave (CW) Doppler pre-attenuation velocity envelope as a potential surrogate for pulsed-wave (PW) Doppler-based interrogation of left ventricular outflow tract (LVOT) flow in patients with moderate or severe aortic stenosis.
methodsIn a retrospective analysis, we examined 92 patients with moderate or severe aortic stenosis. Pulsed-wave Doppler was employed to acquire LVOT velocity and velocity time integral (VTI) in the 5-chamber view. CW Doppler recordings were scrutinized across multiple views with a specific focus on identifying a discernible pre-attenuation velocity envelope. Through manual tracing, we extracted peak velocity and VTI across the aortic valve as well as the pre attenuated velocity, which was used as a surrogate for LVOT assessment and substitute in the continuity equation in the evaluation of aortic valve stenosis.
resultsThe pre-attenuation velocity envelope was distinctly discernible in 83 (90%) of patients. PW Doppler of the LVOT velocity significantly correlated with pre-attenuation velocity from the 5-chamber view (r = 0.75, p-value < 0.001) but showed a weaker correlation when obtained from other windows (r = 0.46, p-value < 0.001). Bland-Altman analyses indicated high levels of agreement between pre-attenuation velocities from the 5-chamber view and PW Doppler derived LVOT velocities, while weaker levels of agreement were observed between pre-attenuation velocities from other windows and PW Doppler derived LVOT velocities.
conclusionsThe pre-attenuation velocity envelope is attainable in the majority of patients with aortic stenosis. The pre-attenuation velocity envelope recorded from the 5-chamber view exhibits a noteworthy correlation and agreement with PW Doppler LVOT velocity. This observation positions pre-attenuation velocity envelope as a promising alternative and plausibility check for hemodynamic assessment in patients with aortic stenosis.
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