Specificity of Doppler echocardiography for the assessment of changes in valvular regurgitation: Comparison of side-by-side versus serial interpretation

OBJECTIVES We sought to determine the specificity of two different methods for assessing change in aortic (AR), mitral (MR) and tricuspid (TR) valvula r regurgitation. BACKGROUND Echocardiographic imaging with Doppler is the standard noninvasi ve diagnostic tool for assessing valvular structure and function. Change ca n be assessed using either independent evaluations (serial) or using a side -by-side comparison, METHODS Subjects were from the placebo arm of a randomized, double-blind, c linical trial. Three echocardiograms over 10 months were performed. An init ial and three-month echocardiogram were read as independent groups, blinded to all parameters except sequence. The initial and 10-month echocardiogram s were read side-by-side, blinded to all parameters including sequence, RESULTS Two hundred nineteen predominantly healthy, obese, white, middle-ag ed women had initial and three-month echocardiograms (acquisition interval 105 +/- 28 days) evaluated by the serial method (mean 167 +/- 61 days betwe en interpretations), The same subjects had the initial and 10-month studies (acquisition interval 303 +/- 27 days) compared side-by-side. The specific ity of the serial versus side-bu-side method for determining change in MR g rade nas 55.8% versus 93.2% (p < 0.001); TR: 63.8% versus 97.6% (p < 0.001) and AR: 93.7% versus 97.6 (p = 0.08). Notably, most of the change occurred in a range (none versus physiologic/mild) that has limited clinical signif icance. Furthermore, the percentage of echocardiograms interpreted as nonev aluable was lower with the side-by-side method for MR (5.0% vs. 16.0%, p = 0.06), TR (4.6% vs. 15.5%, p < 0.001) and AR (4.1% vs. 12.3%, p = 0.002), CONCLUSIONS The side-by-side method of assessing change in valvular regurgi tation appears to be the more reliable method with a higher specificity and minimal data loss. (J Am Coll Cardiol 2001;37:1614-21) (C) 2001 by the Ame rican College of Cardiology.