Abstract

The influence of transmitral filling dynamics on the evaluation of aortic regurgitation (AR) by continuous-wave Doppler pressure half-time was assessed in 30 consecutive patients in sinus rhythm with chronic moderate to severe AR. Pulsed-wave Doppler-derived regurgitant fraction (obtained from aortic and pulmonary stroke volumes) and color flow mapping relative regurgitant area (obtained from the parasternal short-axis view) were chosen as reference standards for the severity of AR. An excellent correlation was found between these 2 parameters (r = 0.98), while correlations were poor between pressure half-time and either regurgitant fraction (r = −0.74) or relative regurgitant jet area (r = −0.69). The ratio of early (E) to late (A) transmitral peak velocities was used to divide the study population into 2 groups: group A (n = 16) with E A <1 and group B (n = 14) with E A >1 . In patients with a similar degree of AR (estimated from Doppler regurgitant fraction or relative regurgitant jet area), the pressure half-time was found to be significantly shorter. Thus, the severity of AR in group A patients was overestimated (p < 0.01). Compared to group B, group A patients were significantly older (p < 0.02) and had a larger left ventricular mass (p < 0.005). The correlation between pressure half-time and either regurgitation fraction (r = −0.85 in group A, r = −0.97 in group B) or relative regurgitant jet area (r = −0.88 in group A, r = −0.93 in group B) markedly improved when patients were divided according to their filling pattern. These data confirm the value of continuous-wave Doppler assessment of the severity of AR by means of pressure half-time measurements. However, because transmitral inflow pattern affects pressure half-time independently of the severity of AR, the method's accuracy is improved by taking the pattern of left ventricular filling into account, and considering a volumetric competition between the phasic transmitral inflow and the AR jet.

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