Circulation, Vol 87, 841-848, Copyright © 1993 by American Heart Association
M Enriquez-Sarano, KR Bailey, JB Seward, AJ Tajik, MJ Krohn and JM Mays
BACKGROUND. Quantitation of valvular regurgitation remains a challenge. The
accuracy of quantitative Doppler is controversial, and its ability to
measure regurgitant volume is unknown; therefore, it is not widely used.
METHODS AND RESULTS. In 120 patients (20 without regurgitation, 19 with
aortic regurgitation, and 81 with mitral regurgitation), the stroke volume
through the mitral annulus and left ventricular outflow tract were measured
using pulsed-wave Doppler concurrently with left ventricular stroke volume
calculated using left ventricular volumes measured by two-dimensional
echocardiography Simpson's biapical method. Regurgitant volume and fraction
were thus computed using Doppler or ventricular methods. In normal patients
there were good correlations between Doppler and left ventricular
measurements of stroke volume. Doppler regurgitant volume and fraction were
4.4 +/- 4.4 mL and 5.3 +/- 4.5%, respectively. In patients with aortic
regurgitation, there were good correlations between Doppler and left
ventricular measurements of stroke volume, regurgitant volume, and
regurgitant fraction (r = 0.97, r = 0.95, and r = 0.93, respectively; p
< 0.0001). In patients with mitral regurgitation, despite good
correlations between Doppler and ventricular methods for stroke volume,
regurgitant volume, and regurgitant fraction (r = 0.94, r = 0.93, and r =
0.94, respectively; p < 0.001), these variables were overestimated by
Doppler. However, in the last 54 patients compared with the first 27,
overestimation decreased significantly for regurgitant volume (5 +/- 10 mL
versus 18 +/- 27 mL, p < 0.05) and regurgitant fraction (3.3 +/- 6.7%
versus 6.2 +/- 6.8%, p = 0.05). CONCLUSIONS. Quantitative Doppler can be
performed in large numbers of patients in a clinical laboratory. Its
potential limitation was identified as overestimation of mitral
regurgitation, which is overcome with increased experience. Its achieved
accuracy in mitral and aortic regurgitation allows measurement not only of
regurgitant fraction but most importantly of regurgitant volume.
ARTICLES
Quantitative Doppler assessment of valvular regurgitation
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
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