Quantification of mitral regurgitation by Doppler echocardiographyZhang,, Y.;Ihlen,, H.;Myhre,, E.;Levorstad,, K.;Nitter-Hauge,, S.
doi: 10.1093/eurheartj/8.suppl_C.59pmid: 3678248
Abstract The present study was undertaken to evaluate a new non-invasive approach to the quantification of mitral regurgitation. Doppler echocardiography and left ventriculography were performed in 20 patients without valvular heart disease (group A), and in 30 patients with pure mitral regurgitation (group B). Volumetric flows through the aortic and mitral valve orifices were determined by Doppler technique. The aortic flow (AF) was calculated as the product of the aortic orifice area by the systolic velocity integral. The mitral flow (MF) was computed as the product of the corrected mitral orifice area by the diastolic velocity integral. The mitral regurgitant fraction (RF) was calculated as RF = 1 − AF/MF. In group A, there was a close agreement between aortic and mitral flows (r = 0.94, P < 0001), and there was no significant difference between the two measurements. In group B, the mitral flow was significantly higher than the aortic flow. The regurgitant fraction assessed by Doppler echocardiography correlated well with the grades of severity of regurgitation obtained at left ventriculography. We conclude that combined measurement of both aortic and mitral flows by Doppler echocardiography provides a new and promising approach to the noninvasive quantification of mitral regurgitation. Mitral regurgitation, volumetric flow measurement, Doppler echocardiography This content is only available as a PDF. © 1987 The European Society of Cardiology
Problems related to the assessment of fluid velocity and volume flow in valve regurgitation using ultrasound Doppler techniqueWranne,, B.;Ask,, P.;Loyd,, D.
doi: 10.1093/eurheartj/8.suppl_C.29pmid: 2960526
Abstract Understanding of the factors affecting regurgitant flow through a heart valve and of the inherent limitations of the Doppler technique is needed to interpret correctly the information obtained during an ultrasound Doppler examination. This paper describes the flow conditions at the leaking valve and limitations of the Doppler technique which become important in the case of valve regurgitation. The flow conditions can be described in the following terms: contraction of the flow, core flow dimensions, friction, and intrusion and width of the jet flow. Contraction occurs at the entrance to the orifice and causes the width of the jet at the orifice to be smaller than the orifice itself. This contraction should be taken into account when calculating volume flow. The jet reaches a minimal area at the vena contracta where the flow velocity is close to that expected from the Bernoulli equation. The area of the vena contracta relative to the area of the hole can vary between 0.6 and 1.0; the lowest value is seen at a sharp-edged orifice and the highest value, at a hole with an ideally rounded inlet. Friction has a marginal role onflow velocity at the vena contracta. The velocity at the vena contracta persists in a region called the core flow region. This region has a length of 4–8 hole diameters. The total jet intrusion and the width of the jet are related to both the flow velocity at the hole and the diameter of the hole. Flow velocities lower than those expected from the Bernoulli relationship, when measured with the ultrasound Doppler technique, can be attributed to geometrical factors at the measurement and inherent limitations of the ultrasound Doppler technique. Hydrodynamics, ultrasound Doppler technique, valvular regurgitation This content is only available as a PDF. © 1987 The European Society of Cardiology
The use of invasive techniques, angiography and indicator dilution, for quantification of valvular regurgitationsKrayenbuehl, H., P.;Ritter,, M.;Hess, O., M.;Hirzel,, H.
doi: 10.1093/eurheartj/8.suppl_C.1pmid: 3315666
Abstract Angiographic techniques have been used for the quantification of mitral or aortic and rarely tricuspid regurgitation. Mitral or aortic regurgitant volume per beat and the regurgitation fraction (fao and fm, respectively) are obtained from the angiographic determination of total left ventricular stroke volume (TSV) and forward stroke volume (FSV) estimated by a different technique. Although this procedure is generally accepted as the gold standard for quantification of left heart regurgitations, there are several limitations: In the presence of mitral and aortic regurgitation no separate quantification of fao and fm is feasible; heart rate at the time of determination of FSV (from Fick or dye dilution cardiac output) and of TSV (angio) may be different; there is a tendency to consistently overestimate stroke volume by angio techniques; repeated estimations of TSV by angio are influenced by the circulatory effects of the contrast dye. In contrast indicator dilution techniques, where upstream and downstream sampling allow the simultaneous estimation of forward and regurgitant flow, the accuracy of the determination of FSV is well established and repeated estimations of fao and fm are possible because the indicators do not have cardiovascular effects. These methods are, however, crucially dependent on thorough mixing of the regurgitant volume with the blood in the upstream chamber. In 23 patients with isolated aortic regurgitation there was a positive correlation between fao evaluated by thermodilution and fao determined by the biplane angio-Fick method (r = 0.59). fao by thermodilution averaged 0.40 and fao by angio-Fick 0.46 (NS). In 23 patients with isolated mitral regurgitation there was also a positive correlation between fm determined by thermodilution and fm determined by angio-Fick (r = 0.71). However, fm by thermodilution was consistently smaller than fm by angio-Fick (average values 0.45 and 0.55, respectively, P < 0.005). Mitral and aortic regurgitation, thermodilution, left ventricular biplane cineangiography This content is only available as a PDF. © 1987 The European Society of Cardiology
Quantification of valvular regurgitation using radioisotopesRigo,, P.;Chevigné,, M.
doi: 10.1093/eurheartj/8.suppl_C.63pmid: 3315668
Abstract Mitral and aortic regurgitations impose an abnormal volume overload on the left ventricle. Recent advances in radionuclide angiographic measurements of all cardiac volumes have made this a practical technique for the detection, quantification and functional assessment of valvular regurgitations and shunts. The method is based on the comparative evaluation of total and effective left ventricular stroke volume. In the radionuclide technique, the right ventricular stroke volume is most frequently used to represent the effective left ventricular stroke volume although techniques have been presented which used as reference the left ventricular stroke volume calculated from measurements of heart rate and cardiac output (Fick method or dye dilution or scintigraphic techniques). The technique can be performed either during first-pass or at equilibrium. Equilibrium measurements are performed in the left anterior oblique position. The stroke volume ratio and the regurgitant fraction are calculated. This technique has been shown to provide adequate quantitative measurements of mitral and aortic regurgitations. Its specificity is adequate with careful positioning and if regions of interest are determined and care is taken to exclude inadequate studies (as these can be prospectively recognized). The technique can separate moderate from severe regurgitation, provide follow-up values for both left ventricular volume and regurgitant fraction, and assess the effect of interventions on the amount of regurgitation. The technique is, however, not adequate to detect mild or minimal regurgitation. In conclusion, equilibrium scintigraphic measurement of valvular regurgitation is an attractive new technique for measuring valvular regurgitation. Its clinical value lies in its simplicity, its reproducibility and its wide applicability. Its accuracy will be improved by performance of gated tomographic acquisitions. Radionuclide angiography, left and right ventricular functions, exercise physiology, valvular regurgitation This content is only available as a PDF. © 1987 The European Society of Cardiology
Value, sensitivity and specificity of stroke volume ratio in routine equilibrium gated scintigraphyGobert,, P.;Krémer,, R.;Rigo,, P.;Cauwe,, F.;Chevigne,, M.
doi: 10.1093/eurheartj/8.suppl_C.77pmid: 2960528
Abstract The stroke volume ratio (SVR) is a new, non invasive method to quantify ventricular volume overload (WO). We have analyzed its value, sensitivity and specificity in routine clinical practice. The results of 238 consecutive patients (pts) were analysed prospectively within a 3 months period. The SVR was expressed as the ratio of left ventricular (LV) stroke counts over the right ventricular (RV) stroke counts measured on the time-activity curves. One region of interest was drawn per ventricle on the phase and amplitude images. Values above 1.6 were considered as LVVO and below 0.9 as RVVO. Fifty-one patients had VVO due to valvular regurgitation or left-to-right shunt; 187 patients had no evidence of WO. Mean value obtained for 23 normal subjects with adequate positioning was 1.27 ± 0.14 (MV ± SD), ranging from 0.9 to 1.47. Among patients with adequate positioning, no difference was observed in subgroups with dilated cardiopathy (DC) or anteroseptal aneurysm (AA) despite a low EF. MV for patients with LV or RV hypertrophy (H) were statistically different. Sensitivity was 82% for the 51 patients with VVO. False negatives were due to biventricular overload or mild WO. Specificity evaluated in the 187 patients without VVO was 76%. The 45 false positives were due to poor separation of the right cardiac chambers and/or of the 2 ventricles. They were observed in 4 patients with AA, 3 patients with DC, 7 patients with LVH, 4 patients with RVH, and 24 patients with inadequate positioning. No explanation was found in 3 patients. We conclude that cardiac equilibrium blood pool scintigraphy has an adequate sensitivity and specificity to evaluate patients with VVO. Stroke volume ratio, gated equilibrium scintigraphy, ventricular volume overload, regurgitation, left-to-right shunt This content is only available as a PDF. © 1987 The European Society of Cardiology
Diagnosis and quantification of aortic regurgitation by pulsed Doppler echocardiography in patients with mitral valve diseaseDittmann,, H.;Karsch, K., R.;Seipel,, L.
doi: 10.1093/eurheartj/8.suppl_C.53pmid: 3678247
Abstract To test the ability of pulsed Doppler echocardiography (PDE) to detect and quantify aortic regurgitation (AR), 55 consecutive patients {14–74 years) with aortic and mitral valve disease were examined clinically and by echocardiography before cardiac catheterisation. The severity of AR was determined angiographically (I–IV) and compared to the extent of the regurgitant jet in the left ventricle measured by PDE. In 13 of 55 patients (3 with mitral stenosis, 3 with mitral incompetence, 3 with combined mitral lesions, 3 with aortic stenosis, one with aortic and mitral stenosis) neither angiography nor PDE showed AR (specificity 100%). Apart from 3 patients with poor echo quality PDE correctly detected AR in 39 of 42 patients (sensitivity 93%). Clinical examination (62%), mode M-mode (62%) and both methods combined (81%) were significantly less sensitive than PDE, especially in mild AR (P < 0.008). The PDE degree of AR closely correlated with angiography (corrected contingency coefficient 0.91). Differentiation between AR III and IV was not possible. Mitral valve disease did not affect quantification of AR (n = 20 patients). Conclusions: Pulsed Doppler echocardiography is better than auscultation and M-mode echocardiography in the diagnosis of aortic regurgitation, especially in grades I and II. PDE can reliably discriminate between three degrees of aortic regurgitation (I–III). Mitral valve disease does not affect quantification of aortic regurgitation by PDE. Aortic regurgitation, pulsed Doppler echocardiography, mitral valve disease, quantification, M-mode This content is only available as a PDF. © 1987 The European Society of Cardiology
Digital videodensitometric measurement of aortic regurgitationDivernois,, J.;Chatelain,, P.;Doriot,, P.-A.;Meier,, B.;Rutishauser,, W.
doi: 10.1093/eurheartj/8.suppl_C.21pmid: 3678246
Abstract A videodensitometric method for quantification of aortic regurgitation which requires neither measurement of cardiac output nor determination of enddiastolic and endsystolic left ventricular volumes has been developed. The injection of 20 ml of contrast medium into the left ventricle is digitally recorded at 25 images s−1 during 20 s using an equipment for digital subtraction angiography (Digitron 2, Siemens). The Digitron computes 2 ‘time dilution curves’ (TDC) from the unsubtracted image sequence, for 2 regions of interest drawn around the angiographic enddiastolic and endsystolic left ventricular silhouettes. Enddiastolic and endsystolic points of the TDC are then entered into a VAX-750 computer, which calculates the ejection fraction (EF), the forward ejection fraction (FEF) and the regurgitant fraction (RGF). This is performed by a complex fitting algorithm based on a physical model of the washout process of contrast medium, which reconstructs the two best enddiastolic and endsystolic baselines in the washout parts of the two TDC. The EF, FEF and RGF obtained in 9 regurgitant and 11 nonregurgitant patients have been compared with the corresponding values EFv, FEFv and RGFv obtained by a conventional technique (Cardiogreen and biplane LV area-length volumetry). Regression analysis yielded: EF = 0.88 × EFv (regression line forced through the origin), r = 0.77, FEF = 0.76 × FEFv + 3, r = 0.96, RGF = 0.94 × RGFv + 5, r = 0.98 (v stands for volumetry). Aortic regurgitation, videodensitometry, digital subtraction angiography, DSA This content is only available as a PDF. © 1987 The European Society of Cardiology
Value of qualitative angiographic grading in aortic regurgitationMichel, P., L.;Vahanian,, A.;Besnainou,, F.;Acar,, J.
doi: 10.1093/eurheartj/8.suppl_C.11pmid: 3678245
Abstract The aim of this study was to assess the accuracy of angiographic grading of regurgitation in patients with aortic regurgitation (AR). In 204 adult patients (149 men, 55 women, aged 51 ± 13 years) with AR, the forward cardiac index was measured by the indicator dilution technique, and the left ventricular angiographic index by the area length method, from which the regurgitant stroke index and the percentage of regurgitation were calculated. In 80 other patients without regurgitation, there was a good correlation between forward and angiographic cardiac indices (r = 0.83, P < 0.001). Aortic regurgitation graded on a 1–4 scale was, in the 204 patients with AR, correlated with the percentage and the volume of regurgitation (respectively r = 0.87, P < 0.001 and r = 0.92, P < 0.001). The regurgitant stroke index and the percentage of regurgitation were significantly different from one group to another (P < 0.001). However, there was a range in amount of regurgitation within each grade and an overlap from one grade to another. There were no differences in regurgitant stroke index or in the percentage of regurgitation when patients were categorized according to LV end-diastolic or endsystolic volume, LV ejection fraction, forward cardiac index or intracardiac pressure. Aortic insufficiency, Qualitative angiography, Quantitative angiography This content is only available as a PDF. © 1987 The European Society of Cardiology