Doppler assessment of mitral regurgitation with orthogonal planes

We evaluated 147 patients with adequate color Doppler and angiographic studies for mitral regurgitation. Sixty-five patients had no mitral regurgitation by both color Doppler and angiography and 82 patients had mitral regurgitation by both techniques. Thus the sensitivity and specificity of color Doppler for the detection of mitral regurgitation was 100%. Three two-dimensional echocardiographic planes (parastemal long and short axis, apical four-chamber view) were used to analyze variables of the mitral regurgitant jet signals in the left atrium. The best correlation with angiography was obtained when the regurgitant jet area (RJA) (maximum or average from three planes) expressed as a percentage of the left atrial area (LAA) obtained in the same plane as the maximum regurgitant area was considered. The maximum RJA/LAA was under 20% in 34 of 36 patients with angiographic grade I mitral regurgitation, between 20% and 40% in 17 of 18 patients with grade II mitral regurgitation, and over 40% in 26 of 28 patients with severe mitral regurgitation. Maximum RJA/LAA also correlated with angiographic regurgitant fractions (r = .78) obtained in 21 of 40 patients in normal sinus rhythm and with no evidence of associated aortic regurgitation. Other variables of the regurgitant jet such as maximal linear and transverse dimensions, maximal area, or maximal area expressed as a percentage of the LAA in one or two planes correlated less well with angiography. Color Doppler is a useful noninvasive technique that is not only highly sensitive and specific in the identification of mitral regurgitation but also provides accurate estimation of its severity. Circulation 75, No. 1, 1 75-183, 1987. THE RECENT DEVELOPMENT of color Doppler flow imaging, which superimposes color-coded flow patterns on real-time two-dimensional images, has made it possible to map abnormal flow patterns such as those seen in patients with valvular regurgitation. Two preliminary studies' 2 have shown its value in the detection and quantitative assessment of mitral regurgitation. However, in both studies color Doppler failed to accurately predict the severity of mitral regurgitation in a significant number of patients. In the present study, we examined the usefulness of color Doppler in the assessment of mitral regurgitation in a comprehensive manner evaluating several criteria and utilizing multiple echocardiographic views.' From the Division of Cardiovascular Disease and Cardiac Radiology, University of Alabama at Birmingham. Address for correspondence: Frederick Helmcke, M.D., University of Alabama at Birmingham, Division of Cardiovascular Disease, Heart Station, SWB/WOO1, Birmingham, AL 35294 Received May 1, 1986; revision accepted Sept. 4, 1986. Vol. 75, No. 1, January 1987 Materials and methods The original study consisted of 160 patients. However, 13 were excluded, eight because of poor acoustic window and inadequate echocardiographic images of the left atrium and five because of the presence of multiple premature ventricular contractions at the time of angiography, making the quantitation of mitral regurgitation impossible. Thus a total of 147 patients who had adequate color Doppler and angiographic examinations form the basis of this study. There were 79 men and 68 women, ranging in age from 17 to 84 years (mean 56). Eighty-two patients had mitral regurgitation by angiography, and the remaining 65 demonstrated normal mitral valvular function. The etiology of mitral regurgitation was ischemic heart disease in 34 rheumatic heart disease in 24, congestive cardiomyopathy in 13, and mitral valve prolapse in 11. Thirty-one of the 82 patients with mitral regurgitation were in atrial fibrillation and the remaining were in normal sinus rhythm. None of the patients without mitral regurgitation were in atrial fibrillation. Concomitant aortic valve disease was present in 22 patients (aortic stenosis in one, aortic insufficiency in 18, and aortic stenosis and insufflciency in three). Cardiac catheterization and angiography. Biplane cineangiography was performed in the standard manner in all patients, and mitral regurgitation was graded according to the criteria of Nagle et al.4: grade I or mild (n = 36), grade II or moderate (n 175 by gest on A ril 7, 2017 http://ciajournals.org/ D ow nladed from