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Quantitative assessment of aortic regurgitation by Doppler echocardiography: Usefulness of the comparison of aortic and pulmonary flows
Author(s) -
Gallais Katell,
Maréchaux Sylvestre,
Czitrom Daniel,
Saunier Carole,
Guerbaai RaphaëlleAshley,
Castel AnneLaure,
Delelis François,
Tribouilloy Christophe,
Ennezat PierreVladimir
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13717
Subject(s) - medicine , regurgitant fraction , cardiology , regurgitation (circulation) , doppler echocardiography , radiology , ejection fraction , heart failure , diastole , blood pressure
Aims Patients with significant (3+/4+) aortic regurgitation ( AR ) require careful monitoring or valve surgery. We sought to evaluate the diagnostic performance of aortic and pulmonary flow comparison in identifying patients with significant AR , by echocardiography. Method Two hundred forty‐six patients with more than trivial AR were prospectively enrolled from three centers. Aortic regurgitation ( AR ) severity was assessed by an expert using the currently recommended integrative approach. Aortic and pulmonary flows were independently assessed by another investigator to calculate the regurgitant fraction ( RF ), the aortic to pulmonary flow ratio (Qao/Qp) and the aortic to pulmonary velocity‐time integral ( VTI ao/ VTI p) ratio. The control group consisted of 195 patients without AR . Results A significant correlation was observed between AR grading and RF ( r = .82, P < .0001) and Qao/Qp ( r = .81, P < .0001), but the correlation was modest for VTI ao/ VTI p ratio ( r = .63; P < .0001). The accuracy of RF and Qao/Qp ratio to identify patients with significant AR was excellent (0.96 and 0.95, respectively), but was significantly lower for VTI ao/ VTI p ratio at 0.82. A RF > 40% indicated grade 3 or 4 AR with a sensitivity of 83% and a specificity of 93%. A Qao/Qp ratio > 1.6 indicated grade 3 or 4 AR with a sensitivity of 88% and a specificity of 89%. The VTI ao/ VTI p ratio was not helpful in identifying patients with significant AR , as a wide overlap was found between 1+/2+ and 3+/4+ patients. Conclusion Regurgitant fraction ( RF ) and Qao/Qp are helpful in identifying significant AR . The assessment of Doppler aortic/pulmonary flow should be incorporated in the comprehensive evaluation of AR .