USEFULNESS OF COLOR DOPPLER PROXIMAL ISOVELOCITY SURFACE-AREA METHOD IRM QUANTITATING VALVULAR REGURGITATION

To define the clinical utility of the color Doppler proximal isoveloci ty surface area (PISA) method for estimating regurgitant stroke volume (SV), 160 regurgitant lesions were evaluated in 104 patients with mit ral (MR), aortic (AR), and tricuspid (TR) regurgitation. Regurgitant S V by PISA was calculated as 2 pi R-2 x V x (time-velocity integral/pea k flow velocity), where R is the radius corresponding to the first blu e-red interface velocity of the maximal PISA during the cardiac cycle. The time-velocity integral and peak flow velocity from the continuous -cave Doppler recording of the regurgitant jet were used to correct PI SA for phasic variations in regurgitant flow. Fifteen lesions were exc luded because of difficulty in tracing the continuous-wave Doppler reg urgitant curve. Among 145 remaining regurgitant lesions, PISA was meas urable in 50 (78%) of 64 cases of MR and 24 (69%) of 35 cases of TR bu t in only 12 (26%) of 46 cases of AR (p < 0.001). Regurgitant SV by PI SA correlated modestly well with jet area/atrial area in all atriovent ricular valve lesions (MR: r = 0.55; TR: r = 0.65; p < 0.001). However , the correlation improved if only central jets were considered (MR: r = 0.70; TR: r = 0.75; p < 0.001). These findings are not unexpected b ecause jet area/atrial area underestimates the true severity of regurg itation in cases of eccentric (wall-impinging) jets. PISA was detected in all severe cases of regurgitation but in only 64% of cases of mild MR, 45% of cases of mild TR, and 6% of cases of mild AR (p < 0.01). T he color Doppler PISA method is clinically useful in estimating regurg itant SV in MR and TR, including mild cases, but is less useful in AR.