Intensity of murmurs correlates with severity of valvular regurgitation

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

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Abstract

PURPOSE: To evaluate the relationship between the intensity of murmurs and severity of mitral and aortic regurgitation. PATIENTS AND METHODS: Consecutive patients with chronic isolated aortic (n = 40) or mitral (n = 170) regurgitation undergoing echocardiographic quantitation of regurgitation between 1990 and 1991 were studied. Regurgitant volume and fraction were measured using two simultaneous methods (quantitative Doppler echocardiography and quantitative two-dimensional echocardiography); the intensity of the regurgitant murmur (grade 0 to 6) was noted by physicians unaware of the study. RESULTS: Correlations between murmur intensity and regurgitant volume and fraction were good in aortic regurgitation (r = .60 and r = .67, respectively; P <0.001) and mitral regurgitation (r = .64 and r = .67, respectively; P <0.001) but weaker (r = .47 and r = .45, respectively) in the subset of mitral regurgitation of ischemic or functional cause. Murmur intensity grades ≥3 for aortic regurgitation and ≥4 for mitral regurgitation predicted severe regurgitation (regurgitant fraction ≥40%) in 71% and 91% of patients, respectively. Murmur grades ≤1 for aortic regurgitation and ≤2 for mitral regurgitation predicted 'not severe' regurgitation in 100% and 88% of patients, respectively. Murmur grades 2 for aortic regurgitation and 3 for mitral regurgitation were not correlated to degree of regurgitation. The severity of regurgitation was the most powerful determinant of intensity of murmur. CONCLUSIONS: Murmur intensity correlates well with the degree of chronic organic aortic and mitral regurgitation, and can be used as a predictor of regurgitation severity and as a simple guideline for diagnostic testing in these patients.

Original languageEnglish (US)
Pages (from-to)149-156
Number of pages8
JournalAmerican Journal of Medicine
Volume100
Issue number2
DOIs
StatePublished - Feb 1996

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Mitral Valve Insufficiency
Aortic Valve Insufficiency
Doppler Echocardiography
Echocardiography
Guidelines
Physicians

ASJC Scopus subject areas

  • Nursing(all)

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Intensity of murmurs correlates with severity of valvular regurgitation. / Desjardins, Valerie A.; Sarano, Maurice E; Tajik, A. Jamil; Bailey, Kent R; Seward, James B.

In: American Journal of Medicine, Vol. 100, No. 2, 02.1996, p. 149-156.

Research output: Contribution to journalArticle

Desjardins, Valerie A. ; Sarano, Maurice E ; Tajik, A. Jamil ; Bailey, Kent R ; Seward, James B. / Intensity of murmurs correlates with severity of valvular regurgitation. In: American Journal of Medicine. 1996 ; Vol. 100, No. 2. pp. 149-156.
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abstract = "PURPOSE: To evaluate the relationship between the intensity of murmurs and severity of mitral and aortic regurgitation. PATIENTS AND METHODS: Consecutive patients with chronic isolated aortic (n = 40) or mitral (n = 170) regurgitation undergoing echocardiographic quantitation of regurgitation between 1990 and 1991 were studied. Regurgitant volume and fraction were measured using two simultaneous methods (quantitative Doppler echocardiography and quantitative two-dimensional echocardiography); the intensity of the regurgitant murmur (grade 0 to 6) was noted by physicians unaware of the study. RESULTS: Correlations between murmur intensity and regurgitant volume and fraction were good in aortic regurgitation (r = .60 and r = .67, respectively; P <0.001) and mitral regurgitation (r = .64 and r = .67, respectively; P <0.001) but weaker (r = .47 and r = .45, respectively) in the subset of mitral regurgitation of ischemic or functional cause. Murmur intensity grades ≥3 for aortic regurgitation and ≥4 for mitral regurgitation predicted severe regurgitation (regurgitant fraction ≥40{\%}) in 71{\%} and 91{\%} of patients, respectively. Murmur grades ≤1 for aortic regurgitation and ≤2 for mitral regurgitation predicted 'not severe' regurgitation in 100{\%} and 88{\%} of patients, respectively. Murmur grades 2 for aortic regurgitation and 3 for mitral regurgitation were not correlated to degree of regurgitation. The severity of regurgitation was the most powerful determinant of intensity of murmur. CONCLUSIONS: Murmur intensity correlates well with the degree of chronic organic aortic and mitral regurgitation, and can be used as a predictor of regurgitation severity and as a simple guideline for diagnostic testing in these patients.",
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AU - Seward, James B.

PY - 1996/2

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N2 - PURPOSE: To evaluate the relationship between the intensity of murmurs and severity of mitral and aortic regurgitation. PATIENTS AND METHODS: Consecutive patients with chronic isolated aortic (n = 40) or mitral (n = 170) regurgitation undergoing echocardiographic quantitation of regurgitation between 1990 and 1991 were studied. Regurgitant volume and fraction were measured using two simultaneous methods (quantitative Doppler echocardiography and quantitative two-dimensional echocardiography); the intensity of the regurgitant murmur (grade 0 to 6) was noted by physicians unaware of the study. RESULTS: Correlations between murmur intensity and regurgitant volume and fraction were good in aortic regurgitation (r = .60 and r = .67, respectively; P <0.001) and mitral regurgitation (r = .64 and r = .67, respectively; P <0.001) but weaker (r = .47 and r = .45, respectively) in the subset of mitral regurgitation of ischemic or functional cause. Murmur intensity grades ≥3 for aortic regurgitation and ≥4 for mitral regurgitation predicted severe regurgitation (regurgitant fraction ≥40%) in 71% and 91% of patients, respectively. Murmur grades ≤1 for aortic regurgitation and ≤2 for mitral regurgitation predicted 'not severe' regurgitation in 100% and 88% of patients, respectively. Murmur grades 2 for aortic regurgitation and 3 for mitral regurgitation were not correlated to degree of regurgitation. The severity of regurgitation was the most powerful determinant of intensity of murmur. CONCLUSIONS: Murmur intensity correlates well with the degree of chronic organic aortic and mitral regurgitation, and can be used as a predictor of regurgitation severity and as a simple guideline for diagnostic testing in these patients.

AB - PURPOSE: To evaluate the relationship between the intensity of murmurs and severity of mitral and aortic regurgitation. PATIENTS AND METHODS: Consecutive patients with chronic isolated aortic (n = 40) or mitral (n = 170) regurgitation undergoing echocardiographic quantitation of regurgitation between 1990 and 1991 were studied. Regurgitant volume and fraction were measured using two simultaneous methods (quantitative Doppler echocardiography and quantitative two-dimensional echocardiography); the intensity of the regurgitant murmur (grade 0 to 6) was noted by physicians unaware of the study. RESULTS: Correlations between murmur intensity and regurgitant volume and fraction were good in aortic regurgitation (r = .60 and r = .67, respectively; P <0.001) and mitral regurgitation (r = .64 and r = .67, respectively; P <0.001) but weaker (r = .47 and r = .45, respectively) in the subset of mitral regurgitation of ischemic or functional cause. Murmur intensity grades ≥3 for aortic regurgitation and ≥4 for mitral regurgitation predicted severe regurgitation (regurgitant fraction ≥40%) in 71% and 91% of patients, respectively. Murmur grades ≤1 for aortic regurgitation and ≤2 for mitral regurgitation predicted 'not severe' regurgitation in 100% and 88% of patients, respectively. Murmur grades 2 for aortic regurgitation and 3 for mitral regurgitation were not correlated to degree of regurgitation. The severity of regurgitation was the most powerful determinant of intensity of murmur. CONCLUSIONS: Murmur intensity correlates well with the degree of chronic organic aortic and mitral regurgitation, and can be used as a predictor of regurgitation severity and as a simple guideline for diagnostic testing in these patients.

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