Towards improving the accuracy of aortic transvalvular pressure gradients: rethinking Bernoulli

The transvalvular pressure gradient (TPG) is commonly estimated using the Bernoulli equation. However, the method is known to be inaccurate. Therefore, an adjusted Bernoulli model for accurate TPG assessment was developed and evaluated. Numerical simulations were used to calculate TPG(CFD) in patient-specific geometries of aortic stenosis as ground truth. Geometries, aortic valve areas (AVA), and flow rates were derived from computed tomography scans. Simulations were divided in a training data set (135 cases) and a test data set (36 cases). The training data was used to fit an adjusted Bernoulli model as a function of AVA and flow rate. The model-predicted TPG(Model) was evaluated using the test data set and also compared against the common Bernoulli equation (TPG(B)). TPG(B) and TPG(Model) both correlated well with TPG(CFD) (r > 0.94), but significantly overestimated it. The average difference between TPG(Model) and TPG(CFD) was much lower: 3.3 mmHg vs. 17.3 mmHg between TPG(B) and TPG(CFD). Also, the standard error of estimate was lower for the adjusted model: SEE(Model) = 5.3 mmHg vs. SEE(B) = 22.3 mmHg. The adjusted model’s performance was more accurate than that of the conventional Bernoulli equation. The model might help to improve non-invasive assessment of TPG. [Figure: see text]