COMPARISON OF TRANSESOPHAGEAL DOPPLER METHODS WITH ANGIOGRAPHY FOR EVALUATION OF THE SEVERITY OF MITRAL REGURGITATION

Doppler evaluation of mitral regurgitation remains difficult; thus, a head-to-head comparison of the diagnostic accuracy of Doppler methods was undertaken. Fifty patients with native mitral regurgitation underw ent multiplane transesophageal echocardiography within 5 days of cathe terization. Angiographic grade of mitral regurgitation and, in 20 pati ents with grade II-IV regurgitation, invasively determined regurgitant stroke volume were compared with color Doppler area, regurgitant jet diameter, ratio of systolic to diastolic peak pulmonary venous flow ve locities, and (based on the proximal convergence zone) maximal regurgi tant flow rate and regurgitant orifice area. Rank correlation coeffici ents of angiographic grade with Doppler parameters were 0.61 for color jet area, -0.61 for pulmonary venous flow velocity ratio, 0.69 for co lor jet diameter, 0.79 for maximal regurgitant flow rate, and 0.78 for regurgitant orifice area (all P < .01). Convergence zone-based parame ters also correlated best(r = 0.73) with invasively determined regurgi tant stroke volume. Receiver operating characteristic curve analysis c onfirmed higher diagnostic accuracy for proximal jet width and proxima l convergence zone parameters than for color jet area or pulmonary ven ous flow velocity ratio. Proximal convergence zone parameters and prox imal color jet diameter best distinguished severe from mild forms of m itral regurgitation.