Quantitative Doppler assessment of valvular regurgitation

Maurice E Sarano, Kent R Bailey, J. B. Seward, A. J. Tajik, M. J. Krohn, J. M. Mays

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)841-848
Number of pages8
JournalCirculation
Volume87
Issue number3
StatePublished - 1993

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Stroke Volume
Mitral Valve Insufficiency
Aortic Valve Insufficiency
Echocardiography

Keywords

  • aortic regurgitation
  • echocardiographic left ventricular volume
  • mitral regurgitation
  • regurgitant fraction

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Sarano, M. E., Bailey, K. R., Seward, J. B., Tajik, A. J., Krohn, M. J., & Mays, J. M. (1993). Quantitative Doppler assessment of valvular regurgitation. Circulation, 87(3), 841-848.

Quantitative Doppler assessment of valvular regurgitation. / Sarano, Maurice E; Bailey, Kent R; Seward, J. B.; Tajik, A. J.; Krohn, M. J.; Mays, J. M.

In: Circulation, Vol. 87, No. 3, 1993, p. 841-848.

Research output: Contribution to journalArticle

Sarano, ME, Bailey, KR, Seward, JB, Tajik, AJ, Krohn, MJ & Mays, JM 1993, 'Quantitative Doppler assessment of valvular regurgitation', Circulation, vol. 87, no. 3, pp. 841-848.
Sarano ME, Bailey KR, Seward JB, Tajik AJ, Krohn MJ, Mays JM. Quantitative Doppler assessment of valvular regurgitation. Circulation. 1993;87(3):841-848.
Sarano, Maurice E ; Bailey, Kent R ; Seward, J. B. ; Tajik, A. J. ; Krohn, M. J. ; Mays, J. M. / Quantitative Doppler assessment of valvular regurgitation. In: Circulation. 1993 ; Vol. 87, No. 3. pp. 841-848.
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abstract = "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.",
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T1 - Quantitative Doppler assessment of valvular regurgitation

AU - Sarano, Maurice E

AU - Bailey, Kent R

AU - Seward, J. B.

AU - Tajik, A. J.

AU - Krohn, M. J.

AU - Mays, J. M.

PY - 1993

Y1 - 1993

N2 - 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.

AB - 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.

KW - aortic regurgitation

KW - echocardiographic left ventricular volume

KW - mitral regurgitation

KW - regurgitant fraction

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