Color flow imaging compared with quantitative Doppler assessment of severity of mitral régurgitation

Influence of eccentricity of jet and mechanism of regurgitation

Maurice E Sarano, A. Jamil Tajik, Kent R Bailey, James B. Seward

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Abstract

Objectives. To determine the influence of jet eccentricity and mechanism of mitral regurgitation, we examined 1) the relation between jet extent and severity of mitral regurgitation, and 2) the use of Doppler color flow imaging for quantitation of mitral regurgitation. Background. Doppler color flow imaging is widely used to assess mitral regurgitation. However, whether, how and in which subgroups it can quantify regurgitation remain controversial. Methods. In 80 patients with mitral regurgitation, results of color flow Doppler studies obtained in two orthogonal apical views were prospectively compared with quantitative Doppler measurement of the regurgitant volume and the regurgitant fraction. Comparisons were made according to the eccentricity of the jet (group 1 eccentric jets, n = 29; group 2 central jets, n - 51); group 2 was subdivided according to the mechanism of mitral regurgitation (group 2a organic, n = 27; group 2b ischemic or functional, n = 24). Results. Globally, weak correlations were found between regurgitant volume and jet area (r = 0.57) and regurgitant fraction and jet are/left atrial area ratio (r = 0.65). Groups 1 and 2 showed a correlation between regurgitant volume and jet area (r = 0.68 and r = 0.65, respectively, p< 0.0001), but the slope was steeper in group 2 than in group 1 (0.22 vs. 0.06, p < 0,0001). The same jet area corresponded to more severe regurgitation in group 1 than in group 2 (jet ≥8 cm2, regurgitant volume 113 ± 55 vs. 43 ± 21 ml, p < 0.0001). Similarly, for comparable regurgitant volumes (24 ± 22 vs. 29 ± 11 ml, p = NS), group 2a had a smaller jet area than did group 2b (5.3 ± 6 vs. 9.6 ± 6 cm2, p < 0.02). Quantitation of regurgitation by Doppler color flow imaging was unreliable in group 1; in group 2b, the regression line between regurgitant fraction and jet area/left atrial area ratio was close to the identity line. Conclusions. Mitral regurgitant jet eccentricity and mechanism influence jet extent. The same regurgitant volume produces smaller jet areas for eccentric compared with central jets and for central organic compared with ischemic or functional regurgitation. Quantitation of regurgitation using Doppler color flow imaging is possible in ischemic or functional regurgitation but inappropriate in eccentric jets, where quantitative Doppler study should be recommended.

Original languageEnglish (US)
Pages (from-to)1211-1219
Number of pages9
JournalJournal of the American College of Cardiology
Volume21
Issue number5
DOIs
StatePublished - 1993

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Mitral Valve Insufficiency
Color

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@article{2f593f569c15438ba69ce04eb9e689cd,
title = "Color flow imaging compared with quantitative Doppler assessment of severity of mitral r{\'e}gurgitation: Influence of eccentricity of jet and mechanism of regurgitation",
abstract = "Objectives. To determine the influence of jet eccentricity and mechanism of mitral regurgitation, we examined 1) the relation between jet extent and severity of mitral regurgitation, and 2) the use of Doppler color flow imaging for quantitation of mitral regurgitation. Background. Doppler color flow imaging is widely used to assess mitral regurgitation. However, whether, how and in which subgroups it can quantify regurgitation remain controversial. Methods. In 80 patients with mitral regurgitation, results of color flow Doppler studies obtained in two orthogonal apical views were prospectively compared with quantitative Doppler measurement of the regurgitant volume and the regurgitant fraction. Comparisons were made according to the eccentricity of the jet (group 1 eccentric jets, n = 29; group 2 central jets, n - 51); group 2 was subdivided according to the mechanism of mitral regurgitation (group 2a organic, n = 27; group 2b ischemic or functional, n = 24). Results. Globally, weak correlations were found between regurgitant volume and jet area (r = 0.57) and regurgitant fraction and jet are/left atrial area ratio (r = 0.65). Groups 1 and 2 showed a correlation between regurgitant volume and jet area (r = 0.68 and r = 0.65, respectively, p< 0.0001), but the slope was steeper in group 2 than in group 1 (0.22 vs. 0.06, p < 0,0001). The same jet area corresponded to more severe regurgitation in group 1 than in group 2 (jet ≥8 cm2, regurgitant volume 113 ± 55 vs. 43 ± 21 ml, p < 0.0001). Similarly, for comparable regurgitant volumes (24 ± 22 vs. 29 ± 11 ml, p = NS), group 2a had a smaller jet area than did group 2b (5.3 ± 6 vs. 9.6 ± 6 cm2, p < 0.02). Quantitation of regurgitation by Doppler color flow imaging was unreliable in group 1; in group 2b, the regression line between regurgitant fraction and jet area/left atrial area ratio was close to the identity line. Conclusions. Mitral regurgitant jet eccentricity and mechanism influence jet extent. The same regurgitant volume produces smaller jet areas for eccentric compared with central jets and for central organic compared with ischemic or functional regurgitation. Quantitation of regurgitation using Doppler color flow imaging is possible in ischemic or functional regurgitation but inappropriate in eccentric jets, where quantitative Doppler study should be recommended.",
author = "Sarano, {Maurice E} and Tajik, {A. Jamil} and Bailey, {Kent R} and Seward, {James B.}",
year = "1993",
doi = "10.1016/0735-1097(93)90248-Y",
language = "English (US)",
volume = "21",
pages = "1211--1219",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Color flow imaging compared with quantitative Doppler assessment of severity of mitral régurgitation

T2 - Influence of eccentricity of jet and mechanism of regurgitation

AU - Sarano, Maurice E

AU - Tajik, A. Jamil

AU - Bailey, Kent R

AU - Seward, James B.

PY - 1993

Y1 - 1993

N2 - Objectives. To determine the influence of jet eccentricity and mechanism of mitral regurgitation, we examined 1) the relation between jet extent and severity of mitral regurgitation, and 2) the use of Doppler color flow imaging for quantitation of mitral regurgitation. Background. Doppler color flow imaging is widely used to assess mitral regurgitation. However, whether, how and in which subgroups it can quantify regurgitation remain controversial. Methods. In 80 patients with mitral regurgitation, results of color flow Doppler studies obtained in two orthogonal apical views were prospectively compared with quantitative Doppler measurement of the regurgitant volume and the regurgitant fraction. Comparisons were made according to the eccentricity of the jet (group 1 eccentric jets, n = 29; group 2 central jets, n - 51); group 2 was subdivided according to the mechanism of mitral regurgitation (group 2a organic, n = 27; group 2b ischemic or functional, n = 24). Results. Globally, weak correlations were found between regurgitant volume and jet area (r = 0.57) and regurgitant fraction and jet are/left atrial area ratio (r = 0.65). Groups 1 and 2 showed a correlation between regurgitant volume and jet area (r = 0.68 and r = 0.65, respectively, p< 0.0001), but the slope was steeper in group 2 than in group 1 (0.22 vs. 0.06, p < 0,0001). The same jet area corresponded to more severe regurgitation in group 1 than in group 2 (jet ≥8 cm2, regurgitant volume 113 ± 55 vs. 43 ± 21 ml, p < 0.0001). Similarly, for comparable regurgitant volumes (24 ± 22 vs. 29 ± 11 ml, p = NS), group 2a had a smaller jet area than did group 2b (5.3 ± 6 vs. 9.6 ± 6 cm2, p < 0.02). Quantitation of regurgitation by Doppler color flow imaging was unreliable in group 1; in group 2b, the regression line between regurgitant fraction and jet area/left atrial area ratio was close to the identity line. Conclusions. Mitral regurgitant jet eccentricity and mechanism influence jet extent. The same regurgitant volume produces smaller jet areas for eccentric compared with central jets and for central organic compared with ischemic or functional regurgitation. Quantitation of regurgitation using Doppler color flow imaging is possible in ischemic or functional regurgitation but inappropriate in eccentric jets, where quantitative Doppler study should be recommended.

AB - Objectives. To determine the influence of jet eccentricity and mechanism of mitral regurgitation, we examined 1) the relation between jet extent and severity of mitral regurgitation, and 2) the use of Doppler color flow imaging for quantitation of mitral regurgitation. Background. Doppler color flow imaging is widely used to assess mitral regurgitation. However, whether, how and in which subgroups it can quantify regurgitation remain controversial. Methods. In 80 patients with mitral regurgitation, results of color flow Doppler studies obtained in two orthogonal apical views were prospectively compared with quantitative Doppler measurement of the regurgitant volume and the regurgitant fraction. Comparisons were made according to the eccentricity of the jet (group 1 eccentric jets, n = 29; group 2 central jets, n - 51); group 2 was subdivided according to the mechanism of mitral regurgitation (group 2a organic, n = 27; group 2b ischemic or functional, n = 24). Results. Globally, weak correlations were found between regurgitant volume and jet area (r = 0.57) and regurgitant fraction and jet are/left atrial area ratio (r = 0.65). Groups 1 and 2 showed a correlation between regurgitant volume and jet area (r = 0.68 and r = 0.65, respectively, p< 0.0001), but the slope was steeper in group 2 than in group 1 (0.22 vs. 0.06, p < 0,0001). The same jet area corresponded to more severe regurgitation in group 1 than in group 2 (jet ≥8 cm2, regurgitant volume 113 ± 55 vs. 43 ± 21 ml, p < 0.0001). Similarly, for comparable regurgitant volumes (24 ± 22 vs. 29 ± 11 ml, p = NS), group 2a had a smaller jet area than did group 2b (5.3 ± 6 vs. 9.6 ± 6 cm2, p < 0.02). Quantitation of regurgitation by Doppler color flow imaging was unreliable in group 1; in group 2b, the regression line between regurgitant fraction and jet area/left atrial area ratio was close to the identity line. Conclusions. Mitral regurgitant jet eccentricity and mechanism influence jet extent. The same regurgitant volume produces smaller jet areas for eccentric compared with central jets and for central organic compared with ischemic or functional regurgitation. Quantitation of regurgitation using Doppler color flow imaging is possible in ischemic or functional regurgitation but inappropriate in eccentric jets, where quantitative Doppler study should be recommended.

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U2 - 10.1016/0735-1097(93)90248-Y

DO - 10.1016/0735-1097(93)90248-Y

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 5

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