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Continuous-wave Doppler echocardiography measures the Doppler frequency distribution of continuously transmitted and received ultrasound through the heart. It can record high flow velocities without the pulse-repetition-frequency aliasing limit of pulsed-wave Doppler echocardiography, but it does not select one depth along the beam. Signals from different contributing locations can overlap.^[ref]

For an aligned flow at speed $v$, the leading Doppler ultrasound relation isWith stipulated transmitted frequency $f_0=2\mathrm{MHz}$, sound speed $c=1540m/s$ and $v=4m/s$, the shift is approximately $10.4\mathrm{kHz}$. A pulsed measurement with pulse repetition frequency $4\mathrm{kHz}$ would have a Doppler Nyquist frequency of only $2\mathrm{kHz}$. Continuous-wave acquisition avoids that particular pulse-rate restriction. Its receiving electronics and digital sampling still have finite bandwidth; continuous transmission does not imply unlimited measurable frequency.

The price is Doppler range ambiguity. If a beam intersects two moving regions, a peak in the spectrum does not by itself label which depth produced it. The anatomical image, direction, timing and waveform context supply additional evidence. The outer spectral envelope describes the fastest detected motion along the beam, rather than a direct spatial average over one known vessel opening.^[ref]

This matters when estimating stroke volume. Multiplying a continuous-wave peak-velocity integral by an arbitrarily selected area can combine measurements from different sites or different parts of a velocity distribution. Flow-profile mismatch in Doppler stroke-volume estimation explains the separate requirement that the chosen velocity represent the area used in the volume calculation.

The velocity-time integral is the area under a velocity-versus-time curve over a specified interval:It has units of length. In Doppler echocardiography, a systolic flow-velocity trace can be integrated to estimate the distance associated with that measured waveform. The interval, sampling site and method of tracing the spectrum are part of the measurement.

The exact volume transported through an opening isFor constant area $A$ and a representative area-mean normal velocity $\bar{v}(t)$, this reduces to $V=A\int \bar{v}(t)dt$. Approximating the left ventricular outflow tract as circular then giveswhere $D$ is the measured diameter, SV is stroke volume, HR is heart rate and CO is cardiac output. The primary Doppler study relates integrated velocity and anatomical area to cardiac output and compares the result with independent methods.^[ref]

For stipulated $D=2.0\mathrm{cm}$ and VTI $=20\mathrm{cm}$, the estimated stroke volume is $20\pi \approx 62.8\mathrm{mL}$. At 75 beats per minute, cardiac output is approximately $4.71L/min$. A triangular waveform with peak $100cm/s$ and duration $0.40\mathrm{s}$ has that same $20\mathrm{cm}$ integral. A trapezoidal waveform with the same peak and duration, but 0.10-second rise and fall, has integral $30\mathrm{cm}$ instead.

The calculation depends quadratically on diameter: a 5% diameter overestimate produces a 10.25% area overestimate at fixed VTI. Flow-profile mismatch in Doppler stroke-volume estimation is a different error: a peak spectral envelope need not equal the area-mean velocity required by the volume integral. A VTI is also not automatically the path length travelled by one identifiable blood cell, since a fixed sampling region can observe different cells over time.