COMPARATIVE VALUE OF DOPPLER-ECHOCARDIOGRAPHY AND CARDIAC-CATHETERIZATION FOR MANAGEMENT DECISION-MAKING IN PATIENTS WITH LEFT-SIDED VALVULAR REGURGITATION

Objective The purpose of this study was to examine the value of non-in vasive clinical and Doppler echocardiographic findings, compared to ca rdiac catherization, in management decision-making for patients with l eft-sided valvular regurgitation. Methods One hundred and thirty-five consecutive patients with left-sided valvular regurgitation who underw ent cardiac catherization and detailed Doppler echocardiography were p rospectively studied. Two independent groups of experienced cardiologi sts, given clinical information combined with either Doppler echocardi ographic or cardiac catherization data, decided to operate, not to ope rate, or remained uncertain. Results In 63 (81%) of 78 patients with m itral regurgitation, there was agreement on the decision for valve sur gery or medical treatment between Doppler echocardiography and cardiac catherization. Valve repair was performed in 22 patients, which agree d with the echocardiographic decision. In the remaining 15 patients, a lthough the severity and type of mitral valve lesions and left ventric ular functional status were confirmed by Doppler echocardiography, the clinical decision was uncertain; additional information concerning co ronary anatomy (13 patients) and pulmonary artery pressure (one patien t) or both (one patient) was required. Ln 47 of 57 patients (82%) with aortic regurgitation, there was Doppler echocardiography alone was un certain and coronary (seven patients), left ventricular (two patients) angiography or aortography (one patient) were requested. Overall, the re were no conflicting clinical decisions made by the two methods in p atients with either mitral or aortic regurgitation. Conclusions In eve ry patient in whom it was considered that a decision could be reached by echocardiography alone (more than 80% of patients) there was 100% a greement from the cardiac catherization assessment group on the manage ment decision. Therefore, in patients with significant mitral or aorti c regurgitation where echocardiographic data is adequate, cardiac cath erization can be safely omitted from the investigative process for sur gery. Where echocardiographic indices are conflicting, or significant coronary artery disease is suspected, cardiac catherization is require d.