Evaluation of aortic regurgitation with digitally determined color doppler-imaged flow convergence acceleration: A quantitative study in sheep

Abstract

The aim of the present study was to validate a digital color Doppler-based centerline velocity/distance acceleration profile method for evaluating the severity of aortic regurgitation. Clinical and in vivo experimental applications of the flow convergence axial centerline velocity/distance profile method have recently been used to estimate regurgitant flow rates and regurgitant volumes in the presence of mitral regurgitation. In six sheep, a total of 19 hemodynamic states were obtained pharmacologically 14 weeks after the original operation in which a portion of the aortic noncoronary (n = 3) or right coronary (n = 3) leaflet was excised to produce aortic regurgitation. Echocardiographic studies were performed to obtain complete proximal axial flow acceleration velocity/distance profiles during the time of peak regurgitant flow (usually early in diastole) for each hemodynamic state. For each steady state, the severity of aortic regurgitation was assessed by measurement of the magnitude of the regurgitant flow volume/beat, regurgitant fraction and instantaneous regurgitant flow rates determined by using both aortic and pulmonary artery electromagnetic flow probes. Grade I regurgitation (regurgitant volume/beat < 15 ml, six conditions), grade II regurgitation (regurgitant volume/beat between 16 ml and 30 ml, five conditions) and grade III-IV regurgitation (regurgitant volume/beat > 30 ml, eight conditions) were clearly separated by using the color Doppler centerline velocity/distance profile domain technique. Additionally, an equation for correlating "a" (the coefficient from the multiplicative curve fit for the velocity/distance relation) with the peak regurgitant flow rates (Q [liters/min]) was derived showing a high correlation between calculated peak flow rates by the color Doppler method and the actual peak flow rates (Q = 13a + 1.0, r = 0.95, p < 0.0001, SEE = 0.76 liters/min). This study, using quantified aortic regurgitation, demonstrates that the flow convergence axial centerline velocity/distance acceleration profile method can be used to evaluate the severity of aortic regurgitation.