Doppler assessment of aortic stenosis: a 25-operator study demonstrating why reading the peak velocity is superior to velocity time integral

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Title: Doppler assessment of aortic stenosis: a 25-operator study demonstrating why reading the peak velocity is superior to velocity time integral
Authors: Sacchi, S
Dhutia, N
Shun-Shin, MJ
Zolgharni, M
Sutaria, N
Francis, DP
Cole, GD
Item Type: Journal Article
Abstract: Aims Measurements with superior reproducibility are useful clinically and research purposes. Previous reproducibility studies of Doppler assessment of aortic stenosis (AS) have compared only a pair of observers and have not explored the mechanism by which disagreement between operators occurs. Using custom-designed software which stored operators’ traces, we investigated the reproducibility of peak and velocity time integral (VTI) measurements across a much larger group of operators and explored the mechanisms by which disagreement arose. Methods and results Twenty-five observers reviewed continuous wave (CW) aortic valve (AV) and pulsed wave (PW) left ventricular outflow tract (LVOT) Doppler traces from 20 sequential cases of AS in random order. Each operator unknowingly measured each peak velocity and VTI twice. VTI tracings were stored for comparison. Measuring the peak is much more reproducible than VTI for both PW (coefficient of variation 10.1 vs. 18.0%; P < 0.001) and CW traces (coefficient of variation 4.0 vs. 10.2%; P < 0.001). VTI is inferior because the steep early and late parts of the envelope are difficult to trace reproducibly. Dimensionless index improves reproducibility because operators tended to consistently over-read or under-read on LVOT and AV traces from the same patient (coefficient of variation 9.3 vs. 17.1%; P < 0.001). Conclusion It is far more reproducible to measure the peak of a Doppler trace than the VTI, a strategy that reduces measurement variance by approximately six-fold. Peak measurements are superior to VTI because tracing the steep slopes in the early and late part of the VTI envelope is difficult to achieve reproducibly.
Issue Date: 1-Dec-2018
Date of Acceptance: 23-Aug-2017
ISSN: 2047-2412
Publisher: Oxford University Press (OUP)
Start Page: 1380
End Page: 1389
Journal / Book Title: EHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging
Volume: 19
Issue: 12
Copyright Statement: © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: British Heart Foundation
British Heart Foundation
British Heart Foundation
Funder's Grant Number: FS/10/38/28268
Keywords: echocardiography
valvular heart disease
Publication Status: Published
Online Publication Date: 2018-01-15
Appears in Collections:Faculty of Engineering
National Heart and Lung Institute
Faculty of Medicine

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