Ejection Fraction - Velocity Ratio


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Echocardiography. 2006 Feb;23(2):97-102.
Use of the ejection fraction-velocity ratio in the hemodynamic assessment of aortic bioprosthetic valves.
Antonini-Canterin F, Allocca G, Rivaben D, Korcova-Miertusova R, Pezzutto N, Pascotto A, Cervesato E, Pavan D, Piazza R, Nicolosi GL. Unità Operativa di Cardiologia ARC, Azienda Ospedaliera S. Maria degli Angeli, Pordenone, Italy. cardiologia@aopn.fvg.it

BACKGROUND: A new echocardiographic severity index of aortic valve stenosis has been recently introduced: the ejection fraction-velocity ratio (EFVR), which is a simple ratio ejection fraction/4Vmax2. This nonflow corrected index demonstrated an excellent accuracy in quantifying the effective orifice area (EOA) in native aortic valves. There is no information about the reliability of EFVR in assessing aortic EOA in patients with bioprostheses. METHODS: In 141 consecutive patients with aortic bioprostheses (85 males, mean age 74 +/- 9 years), EOA was calculated by both continuity equation (CE) and EFVR. RESULTS: The correlation between CE and EFVR was highly significant (r = 0.88; P < 0.0001). The area under the receiver operating characteristic (ROC) curve was 0.97 (considering a positive case CE < 1.0 cm2, best cutoff of EFVR was <1.06). Using CE as gold standard and a cutoff of 1.0 for both indexes, EFVR showed good sensitivity (80%) and specificity (98%). Also in a subgroup of 46 patients with moderate or severe mitral regurgitation, the EFVR had a good diagnostic accuracy (sensitivity 89%, specificity 97%). In 91 patients with ejection fraction < or = 50%, the EFVR confirmed good sensitivity (79%) and specificity (97%). CONCLUSIONS: The EFVR, a simple and not time-consuming index, demonstrated a good diagnostic accuracy in assessing EOA also in patients with aortic bioprostheses. The presence of moderate to severe mitral regurgitation or left ventricular dysfunction does not reduce significantly the reliability of this new index. The EFVR can be taken into consideration in the clinical practice, at least when CE measurements are technically difficult.


Echocardiography. 2005 Mar;22(3):195-202.
Ejection fraction velocity ratio as an indicator of aortic stenosis severity.
Al-Ghamdi AM, Melendez LJ, Massel D.
The Department of Medicine, Division of Cardiology, London Health Sciences Centre, Victoria Campus, University of Western Ontario, London, Ontario, Canada.

BACKGROUND: Despite the widespread use of the continuity equation in the estimation of aortic valve area (AVA) in patients with aortic stenosis, it is subject to errors, time consuming, and can be technically demanding. As such, simpler methods of assessing aortic stenosis severity have been pursued. METHODS: The ejection fraction velocity ratio [EFVR = ejection fraction (%) / maximal aortic velocity (m/sec)] was compared to AVA determined with the continuity equation in 857 patients with aortic stenosis and varying degrees of LV systolic dysfunction. Severe aortic stenosis was defined as an AVA < 1.0 cm2. RESULTS: There was good to excellent correlation between our index and aortic valve area (P < 0.001 for each ejection fraction subgroup). Receiver operating characteristic analysis showed that the EFVR functioned well with areas under the curve between 0.893 and 0.938. CONCLUSION: The EFVR is a simple noninvasive method for screening patients for an AVA of 1.0 cm2. It could be used as a screening test or in lieu of the continuity equation particularly when there is problematic measurement of either the LVOT diameter or velocity.


Am J Cardiol. 2000 Aug 15;86(4):427-33.
Validation of the ejection fraction-velocity ratio: a new simplified "function-corrected" index for assessing aortic stenosis severity.
Antonini-Canterin F, Pavan D, Burelli C, Cassin M, Cervesato E, Nicolosi GL.
Divisione di Cardiologia, ARC, Azienda Ospedaliera Santa Maria degli Angeli, Pordenone, Italy.

A new echocardiographic method for the evaluation of aortic stenosis (AS) severity has recently been introduced: the fractional shortening-velocity ratio (FSVR = fractional shortening/4 Vmax(2)). An important advantage of the method is the possibility of avoiding the difficulties related to the measurement of left ventricular outflow tract in calcific AS for assessing the continuity equation. FSVR, however, also shows some significant limitations especially in patients with regional wall motion abnormalities and conduction defects. To overcome this problem, we developed a new index: the ejection fraction-velocity ratio (EFVR = ejection fraction/4 Vmax(2)), where percent ejection fraction and Vmax have been obtained with an apical echocardiographic approach. In 343 consecutive patients with AS, aortic valve area was measured by cardiac catheterization (Gorlin), whereas FSVR and EFVR were calculated by echo-Doppler examination performed within 24 hours. Mean valve area was 0.70 +/- 0.30 cm(2), mean EFVR was 0.78 +/- 0.41, and mean FSVR was 0.45 +/- 0.26. The linear correlation area-EFVR was highly significant (r = 0.88). Correlation valve area-FSVR was also significant (r = 0.82). EFVR allowed identification of patients with severe AS (area


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