Strategy for optimal aortic regurgitation quantification by Doppler echocardiography: Agreement among different methods

Background Although different Doppler methods have been validated for aorti c regurgitation quantification, the benefit of combining information from d ifferent methods has not been defined. Methods Our study included 2 phases. In the initial phase (60 patients), Do ppler parameters (jet width, short-axis jet area, apical jet area, regurgit ant fraction from pulmonary and mitral flow, and deceleration slope) were c orrelated with angiography; range values for each severity grade were defin ed and intraobserver and interobserver and intermachine variability were st udied. In the validation phase (158 patients), defined value ranges were pr ospectively tested and a strategy based on considering as the definitive se verity grade that in which the two best methods agreed was tested. Results Jet width had the best correlation with angiography (r = 0.91), and its ratio with the left ventricular outflow diameter did not improve the c orrelation (r = 0.85) and decreased reproducibility. Apical jet area and re gurgitant fraction from pulmonary flow permitted acceptable quantification (r = 0.87 and 0.86, respectively) but with worse reproducibility. The other methods were not assessable in 20% to 30% of studies. Concordance with ang iography decreased in jet width when the jet was eccentric (90% vs 77%, P < .01), in apical jet area when mitral valve disease was present (84% vs 65% , P < .02), and in short-axis let area and regurgitant fraction from pulmon ary flow with concomitant aortic stenosis (77% vs 44%, P < .002 and 77% vs 53%, P < .02, respectively). Agreement with angiography was very high (94 [ 95%] of 99) when severity grade coincided in both jet width and apical jet area. In 59 cases without concordance, regurgitant fraction from pulmonary flow was used as a third method. Overall, this strategy permitted concordan ce with angiography in 146 patients (92%). Conclusions Jet width is the best predictor in aortic regurgitation quantif ication by Doppler echocardiography. However, better results were obtained when a strategy based on concordance between jet width and another Doppler method was established, particularly when the jet was eccentric.