Assessment of severity of aortic regurgitation using the width of the venacontracta - A clinical color Doppler imaging study

Background-The width of the vena contracta (VC-W), the smallest area of reg urgitant flow, reflects the degree of valvular regurgitation and is measura ble by color Doppler imaging, but this method has not been validated in aor tic regurgitation (AR). Methods and Results-We prospectively examined 79 patients with isolated AR and 80 patients without regurgitation. The VC-W was measured from the long- axis parasternal view and compared with 2 simultaneous reference methods (q uantitative Doppler and 2D echocardiography). In patients without regurgita tion, the agreement between methods was excellent. In patients with AR, goo d correlations (all P<0.0001) were obtained between VC-W and effective regu rgitant orifice (ERO) area and regurgitant volume recorded by quantitative Doppler (r=0.89 and 0.90, respectively) and 2D echocardiographic (r=0.90 an d 0.89, respectively) methods. These correlations were similar with eccentr ic or central jets (all P>0.60). The other methods used showed good correla tions of VC-W with aortographic grading of AR (n=8, r=0.82, P=0.01), with t he proximal flow convergence method (n=53, r=0.85, P<0.0001), and with left ventricular end-diastolic volume (r=0.81, P<0.0001). Sensitivity and speci ficity of VC-W greater than or equal to 6 mm for diagnosing severe AR (ERO greater than or equal to 30 mm(2)) were 95% and 90%, respectively. Conclusions-For assessment of the degree of AR, VC-W shows good correlation s with simultaneous quantitative measures (regardless of jet direction), sh ows good correlations with other methods of assessment of AR, and provides a high diagnostic value for severe AR. VC-W is a simple, reliable method th at can be used clinically as part of comprehensive Doppler echocardiographi c assessment of AR.