Quantitative assessment of mitral regurgitation by doppler echocardiography: value of multifactorial approach

ABSTRACT

This study was undertaken to assess the value of Doppler echocardiographic parameters taken singly and in association for the quantification of mitral regurgitation. Fifty-eight patient, with angiographically mild [Group I,n=21], moderate [Group II, n=9] or severe [Group III, n=28] mitral regurgitation, underwent Doppler echocardiographic examination. The following parameters were chosen for the study; maximum color Doppler regurgitant jet area, ratio of maximum regurgitant jet area to left t atrial area, width of the reguritantjet at its origin, maximum regurgitant jet length, peak early velocity of mitral inflow, and intensity of regurgitant signal on continuous wave Doppler [CW] graded 1 to 3. univariate statistical analysis showed that maximum regurgitation jet area >8.1 cm° predicted the presence of severe regurgitation with a sensitivity of 50% and a specificity of 100. peak early velocities of mitral inflow over 1.7 m/s identified Group III patients with sensitivity of 54% and a specificity of 100%.finally, Grade 3 CW signal intensity predicted severe regurgitation with a sensitivity of 86%and a specificity of 97%. A score was elaborated from multivariate analysis based on maximum regurgitant jet area and continuous wave signal intensity. All patients with scores over 3.5 [n=14] had severe regurgitation and patients with a score of0 or less [n=23] had mild to moderate mitral regurgitation. Left ventriculography was required to differentiate patients with intermediate scores [n=21]. Non-invasive Doppler echocardiographic quantification of mitral regurgitation remains difficult even when a multifactorial approach is used. However, severe regurgitation can be reliably diagnosed or excluded in more than 60% of cases by this method: