QUANTIFICATION OF AORTIC REGURGITATION - A COMPARISON BETWEEN DOPPLER-ECHOCARDIOGRAPHIC AND QUALITATIVE ANGIOGRAPHIC METHODS IN 60 CONSECUTIVE PATIENTS

Many doppler echocardiographic indices have been described for quantif ying aortic regurgitation, posing the problem of the relative value of each. Therefore, the authors assessed the severity of aortic regurgit ation in 60 consecutive patients (16 women and 44 men, mean age 56.7 y ears, range 7 to 84 years) by the four grades of Seller's classificati on with selective aortography. These results were compared with Dopple r echocardiographic measurement of anterograde cardiac output (Qao), t he pressure half time (PHT), diameter of the jet at its origin in M mo de colour Doppler (DTM) and calculation of the regurgitant fraction (R F) by comparison of flow at the different cardiac orifices by a method previously described and validated in the authors' laboratory with an interorifice correlation of 0.91 to 0.96 and confidence intervals at 95 % of the order of 12 %. The feasability of doppler echocardiographi c methods was good: 87.8 % for PHT (58/66 patients), 90 % for DTM (36/ 40 patients), 90.9 % for Qao and RF (60/66 patients). The correlation with aortography was -0.65 (p < 0.01) for PHT;0.91 (p < 0.01) for DTM, 0.80 (p < 0.01) for Qao and 0.92 (p < 0.005) for RE However, there wa s a number of overlaps between Grades I and II and Grades III and IV. If two groups of patients identified by angiography, one with minimal to mild aortic regurgitation and the other with severe regurgitation, are considered, 72.5 % (42/58 patients) were correctly classified by t he PHT method with an optimal threshold value of 400 cm/s; 97.3 % (35/ 36) were correctly classified by measuring DTM with an optimal thresho ld value of 8 mm; 80 % (48/60) were correctly classified by measuring Qao with an optimal threshold Value of 8 l/min and, finally, 88.4 % (5 3/60) were correctly classified by calculating the RF with an optimal threshold value of 30 %. When a synthesis of these Doppler echocardiog raphic parameters was carried out, 86.1 % (31/36 patients) were correc tly classified with a sensitivity of 0.83 and specificity of 0.89. The refore, each index has its own usefulness for assessing the severity o f aortic regurgitation. The quantification of this type of valvular le sion requires a synthesis of echocardiographic Doppler and clinical pa rameters.