The Quest for the Unholy Grail

Excerpt

In their study titled “Clinical Utility of Doppler Echocardiography in Assessing Aortic Stenosis Severity and Predicting Need for Intervention in Children,” Vlahos et al. [20] embark upon a noble quest attempting to use Doppler echocardiographic data to predict the “grail” of catheterization-derived aortic stenosis gradient. They discover that the catheterization gradient is best predicted by an average of the two Doppler peak instantaneous gradients obtained from the apical five-chamber view and a high parasternal view. Furthermore, although the negative predictive value of a peak instantaneous gradient from the high parasternal view of ≤55 mmHg is perfect, receiver operator characteristic curve areas are only modest so that the decision to intervene in a child with valvar aortic stenosis based on a single Doppler measurement or site is only marginally helpful. …