Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation: Clinical implications

David Messika-Zeitoun, Delphine Detaint, Mohamed Leye, Christophe Tribouilloy, Hector I Michelena, Sorin Pislaru, Eric Brochet, Bernard Iung, Alec Vahanian, Maurice E Sarano

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Recent studies have emphasized the importance of quantitative assessment of the degree of aortic regurgitation (AR). However, semiquantitative methods have remained mainly used despite their unclear diagnostic value. The aim of this study was to define the sensitivity and specificity of semiquantitative methods compared with the proximal isovelocity surface area method as a reference for the diagnostic of severe AR. Methods: The degree of AR was evaluated using the proximal isovelocity surface area method and four semiquantitative measurements (left ventricular cardiac output, pressure half-time, diastolic flow reversal, and vena contracta) in 224 patients with a wide range of AR severity. Results: The mean effective regurgitant orifice area was 25 ± 14 mm 2 (range, 3-69 mm 2), the mean regurgitant volume was 57 ± 31 mL (range, 9-183 mL), and 100 patients (44%) had severe AR (effective regurgitant orifice area ≥ 30 mm 2 or regurgitant volume ≥ 60 mL). Overall, semiquantitative methods had good specificity but poor sensitivity, except the vena contracta, which had good sensitivity and specificity. Sensitivity, specificity, and positive and negative predictive values of the recommended thresholds for severe AR of the four semiquantitative methods were 53%, 89%, 77%, and 73% for left ventricular cardiac output ≥ 10 L/min; 12%, 100%, 100%, and 52% for pressure half-time < 200 msec; 45%, 87%, 79%, and 60% for diastolic flow reversal ≥ 18 cm/sec; and 81%, 83%, 78%, and 85% for vena contracta ≥ 6 mm, respectively. Conclusions: For the assessment of AR severity, current thresholds appear specific but poorly sensitive, except for vena contracta, which provides good discriminative value. Semiquantitative methods should be integrated into the comprehensive evaluation of AR severity, but severe AR should not be excluded only on the basis of semiquantitative criteria. These results emphasize the need for the quantitative assessment of AR severity.

Original languageEnglish (US)
Pages (from-to)1246-1252
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume24
Issue number11
DOIs
StatePublished - Nov 2011

Fingerprint

Aortic Valve Insufficiency
Sensitivity and Specificity
Cardiac Output
Pressure
Needs Assessment

Keywords

  • Aortic regurgitation
  • Echocardiography
  • Quantification

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation : Clinical implications. / Messika-Zeitoun, David; Detaint, Delphine; Leye, Mohamed; Tribouilloy, Christophe; Michelena, Hector I; Pislaru, Sorin; Brochet, Eric; Iung, Bernard; Vahanian, Alec; Sarano, Maurice E.

In: Journal of the American Society of Echocardiography, Vol. 24, No. 11, 11.2011, p. 1246-1252.

Research output: Contribution to journalArticle

Messika-Zeitoun, David ; Detaint, Delphine ; Leye, Mohamed ; Tribouilloy, Christophe ; Michelena, Hector I ; Pislaru, Sorin ; Brochet, Eric ; Iung, Bernard ; Vahanian, Alec ; Sarano, Maurice E. / Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation : Clinical implications. In: Journal of the American Society of Echocardiography. 2011 ; Vol. 24, No. 11. pp. 1246-1252.
@article{818273283616425899051e5530646b6f,
title = "Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation: Clinical implications",
abstract = "Background: Recent studies have emphasized the importance of quantitative assessment of the degree of aortic regurgitation (AR). However, semiquantitative methods have remained mainly used despite their unclear diagnostic value. The aim of this study was to define the sensitivity and specificity of semiquantitative methods compared with the proximal isovelocity surface area method as a reference for the diagnostic of severe AR. Methods: The degree of AR was evaluated using the proximal isovelocity surface area method and four semiquantitative measurements (left ventricular cardiac output, pressure half-time, diastolic flow reversal, and vena contracta) in 224 patients with a wide range of AR severity. Results: The mean effective regurgitant orifice area was 25 ± 14 mm 2 (range, 3-69 mm 2), the mean regurgitant volume was 57 ± 31 mL (range, 9-183 mL), and 100 patients (44{\%}) had severe AR (effective regurgitant orifice area ≥ 30 mm 2 or regurgitant volume ≥ 60 mL). Overall, semiquantitative methods had good specificity but poor sensitivity, except the vena contracta, which had good sensitivity and specificity. Sensitivity, specificity, and positive and negative predictive values of the recommended thresholds for severe AR of the four semiquantitative methods were 53{\%}, 89{\%}, 77{\%}, and 73{\%} for left ventricular cardiac output ≥ 10 L/min; 12{\%}, 100{\%}, 100{\%}, and 52{\%} for pressure half-time < 200 msec; 45{\%}, 87{\%}, 79{\%}, and 60{\%} for diastolic flow reversal ≥ 18 cm/sec; and 81{\%}, 83{\%}, 78{\%}, and 85{\%} for vena contracta ≥ 6 mm, respectively. Conclusions: For the assessment of AR severity, current thresholds appear specific but poorly sensitive, except for vena contracta, which provides good discriminative value. Semiquantitative methods should be integrated into the comprehensive evaluation of AR severity, but severe AR should not be excluded only on the basis of semiquantitative criteria. These results emphasize the need for the quantitative assessment of AR severity.",
keywords = "Aortic regurgitation, Echocardiography, Quantification",
author = "David Messika-Zeitoun and Delphine Detaint and Mohamed Leye and Christophe Tribouilloy and Michelena, {Hector I} and Sorin Pislaru and Eric Brochet and Bernard Iung and Alec Vahanian and Sarano, {Maurice E}",
year = "2011",
month = "11",
doi = "10.1016/j.echo.2011.08.009",
language = "English (US)",
volume = "24",
pages = "1246--1252",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Mosby Inc.",
number = "11",

}

TY - JOUR

T1 - Comparison of semiquantitative and quantitative assessment of severity of aortic regurgitation

T2 - Clinical implications

AU - Messika-Zeitoun, David

AU - Detaint, Delphine

AU - Leye, Mohamed

AU - Tribouilloy, Christophe

AU - Michelena, Hector I

AU - Pislaru, Sorin

AU - Brochet, Eric

AU - Iung, Bernard

AU - Vahanian, Alec

AU - Sarano, Maurice E

PY - 2011/11

Y1 - 2011/11

N2 - Background: Recent studies have emphasized the importance of quantitative assessment of the degree of aortic regurgitation (AR). However, semiquantitative methods have remained mainly used despite their unclear diagnostic value. The aim of this study was to define the sensitivity and specificity of semiquantitative methods compared with the proximal isovelocity surface area method as a reference for the diagnostic of severe AR. Methods: The degree of AR was evaluated using the proximal isovelocity surface area method and four semiquantitative measurements (left ventricular cardiac output, pressure half-time, diastolic flow reversal, and vena contracta) in 224 patients with a wide range of AR severity. Results: The mean effective regurgitant orifice area was 25 ± 14 mm 2 (range, 3-69 mm 2), the mean regurgitant volume was 57 ± 31 mL (range, 9-183 mL), and 100 patients (44%) had severe AR (effective regurgitant orifice area ≥ 30 mm 2 or regurgitant volume ≥ 60 mL). Overall, semiquantitative methods had good specificity but poor sensitivity, except the vena contracta, which had good sensitivity and specificity. Sensitivity, specificity, and positive and negative predictive values of the recommended thresholds for severe AR of the four semiquantitative methods were 53%, 89%, 77%, and 73% for left ventricular cardiac output ≥ 10 L/min; 12%, 100%, 100%, and 52% for pressure half-time < 200 msec; 45%, 87%, 79%, and 60% for diastolic flow reversal ≥ 18 cm/sec; and 81%, 83%, 78%, and 85% for vena contracta ≥ 6 mm, respectively. Conclusions: For the assessment of AR severity, current thresholds appear specific but poorly sensitive, except for vena contracta, which provides good discriminative value. Semiquantitative methods should be integrated into the comprehensive evaluation of AR severity, but severe AR should not be excluded only on the basis of semiquantitative criteria. These results emphasize the need for the quantitative assessment of AR severity.

AB - Background: Recent studies have emphasized the importance of quantitative assessment of the degree of aortic regurgitation (AR). However, semiquantitative methods have remained mainly used despite their unclear diagnostic value. The aim of this study was to define the sensitivity and specificity of semiquantitative methods compared with the proximal isovelocity surface area method as a reference for the diagnostic of severe AR. Methods: The degree of AR was evaluated using the proximal isovelocity surface area method and four semiquantitative measurements (left ventricular cardiac output, pressure half-time, diastolic flow reversal, and vena contracta) in 224 patients with a wide range of AR severity. Results: The mean effective regurgitant orifice area was 25 ± 14 mm 2 (range, 3-69 mm 2), the mean regurgitant volume was 57 ± 31 mL (range, 9-183 mL), and 100 patients (44%) had severe AR (effective regurgitant orifice area ≥ 30 mm 2 or regurgitant volume ≥ 60 mL). Overall, semiquantitative methods had good specificity but poor sensitivity, except the vena contracta, which had good sensitivity and specificity. Sensitivity, specificity, and positive and negative predictive values of the recommended thresholds for severe AR of the four semiquantitative methods were 53%, 89%, 77%, and 73% for left ventricular cardiac output ≥ 10 L/min; 12%, 100%, 100%, and 52% for pressure half-time < 200 msec; 45%, 87%, 79%, and 60% for diastolic flow reversal ≥ 18 cm/sec; and 81%, 83%, 78%, and 85% for vena contracta ≥ 6 mm, respectively. Conclusions: For the assessment of AR severity, current thresholds appear specific but poorly sensitive, except for vena contracta, which provides good discriminative value. Semiquantitative methods should be integrated into the comprehensive evaluation of AR severity, but severe AR should not be excluded only on the basis of semiquantitative criteria. These results emphasize the need for the quantitative assessment of AR severity.

KW - Aortic regurgitation

KW - Echocardiography

KW - Quantification

UR - http://www.scopus.com/inward/record.url?scp=80055017682&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80055017682&partnerID=8YFLogxK

U2 - 10.1016/j.echo.2011.08.009

DO - 10.1016/j.echo.2011.08.009

M3 - Article

C2 - 21940147

AN - SCOPUS:80055017682

VL - 24

SP - 1246

EP - 1252

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 11

ER -