Correlation between transthoracic echocardiography and cardiac catheterization in the grading of aortic and mitral valve disease in clinical practice

Background: Prospective studies in selected patients showed a good correlation between transthoracic echocardiography and cardiac catheterization in the grading of the severity of valvular heart disease. However there are only a few studies concerning the same issue in clinical practice. Patients and methods: Retrospectively all patients with aortic or mitral valve disease receiving cardiac catheterization between 1/88 and 12/91 were analysed. Results of echocardiography and cardiac catheterization were compared. Of 404 patients 234 had aortic valve disease, 232 mitral valve disease and 62 patients suffered from both. Results: For aortic stenosis echocardiography showed a sensitivity of 93% and a specifity of 98%. The coefficient of agreement (kappa) was 0.74 for overall grading. Correlation coefficient was 0.68 (n = 117) for maximum pressure gradient and 0.59 (n = 65) for aortic valve area. For aortic insufficiency the coefficient of agreement (kappa) for grading was 0.49. In mitral stenosis echocardiography showed a sensitivity of 100% and a specifity of 99%. Coefficient of agreement (kappa) for grading was 0.74 and the correlation coefficient for mitral valve area was 0.67 (n = 21). For mitral insufficiency sensitivity was 70% and specifity 81%. The coefficient of agreement (kappa) for grading was 0.41. Conclusion: In clinical practice with not selected patients there are worse correlations between echocardiography and cardiac catheterization for all parameters and all valves investigated compared to simultaneous studies in selected patients. This is especially true in patients with valvular insufficiencies, however the differences between the two methods are normally only minor.