OVERESTIMATION OF SEVERITY OF ISCHEMIC FUNCTIONAL MITRAL REGURGITATION BY COLOR DOPPLER JET AREA

Color Doppler jet analysis is widely used to characterize the degree o f mitral regurgitation (MR), but the validity of this approach in pati ents with ischemic or functional MR has not been established. It was h ypothesized that color Doppler jet area overestimates the magnitude of MR of ischemic or functional origin. The severity of isolated MR in 1 70 patients was measured by using Doppler/echocardiography. Group 1 (n = 58) included patients with ischemic or functional MR, and group 2 ( n = 112) included those with organic MR. The regurgitant jet area and 2 methods of quantitation (quantitative Doppler and quantitative 2-dim ensional echocardiography) were measured simultaneously. In group 1, c olor jet area was larger (10.6 +/- 5.3 vs 8.2 +/- 5.3 cm(2), p = 0.004 ) but corresponded to a smaller regurgitant volume and regurgitant fra ction by quantitative Doppler (28 +/- 14 vs 55 +/- 46 ml, p = 0.0006, and 31 +/- 12% vs 38 +/- 20%, p = 0.02, respectively) and by quantitat ive 2-dimensional echocardiography (22 +/- 11 VS 49 +/- 40 ml, p < 0.0 001, and 27 +/- 12% vs 36 +/- 20%, p = 0.005, respectively). Enlargeme nt of the left-sided chambers was more marked in group 1. In ischemic/ functional MR, the diagnosis of severe regurgitating by color Doppler (jet area > 8 cm(2)) was confirmed by quantitative methods (regurgitan t fraction greater than or equal to 50%) in only 6% to 11% of patients , whereas it was confirmed in 60% to 73% of patients with organic MR ( p < 0.001). In conclusion, in ischemic/functional MR versus organic MR , (1) a larger color jet area corresponds to a smaller regurgitant vol ume and fraction, and (2) contrary to established criteria most large jets (> 8 cm(2)) do not correspond to severe MR. Therefore, quantitati ve methods should be used routinely to determine the severity of ische mic/functional MR.