Author + information
- Received September 17, 1993
- Revision received March 2, 1994
- Accepted March 31, 1994
- Published online September 1, 1994.
- Takahiro Shiota, MD1,
- Michael Jones, MD∗,
- Dag Teien, MD1,
- Izumi Yamada, MD∗,
- Arnaldo Passafini, MD1,
- Ole Knudson, RDMS1 and
- David J. Sahn, MD, FACC1,∗
- ↵∗Address for correspondence: Dr. David J. Sahn, The Clinical Care Center for Congenital Heart Disease, UHN60, Oregon Health Sciences University, Portland, Oregon 97201-3181.
Objectives. The purpose of the present study was to rigorously evaluate the accuracy of the color Doppler jet area planimetry method for quantifying chronic mitral regurgitation.
Background. Although the color Doppler jet area has been widely used clinically for evaluating the severity of mitral regurgitation, there have been no studies comparing the color jet area with a strictly quantifiable reference standard for determining regurgitant volume.
Methods. In six sheep with surgically produced chronic mitral regurgitation, 24 hemodynamically different states were obtained. Maximal color Doppler jet area for each state was obtained with a Vingmed 750. Image data were directly transferred in digital format to a microcomputer. Mitral regurgitation was quantified by the peak and mean regurgitant flow rates, regurgitant stroke volumes and regurgitant fractions determined using mitral and aortic electromagnetic flow probes.
Results. Mean regurgitant volumes varied from 0.19 to 2.4 liters/ min (mean [±SD] 1.2 ± 0.59), regurgitant stroke volumes from 1.8 to 29 ml/beat (mean 11 ± 6.2), peak regurgitant volumes from 1.0 to 8.1 liters/min (mean 3.5 ± 2.1) and regurgitant fractions from 8.0% to 54% (mean 29 ± 12%). Twenty-two of 24 jets were eccentric. Simple linear regression analysis between maximal color jet areas and peak and mean regurgitant flow rates, regurgitant stroke volumes and regurgitant fractions showed correlation, with r = 0.68 (SEE 0.64 cm2), r = 0.63 (SEE 0.67 cm2), r = 0.63 (SEE 0.67 cm2) and r = 0.58 (SEE 0.71 cm2), respectively. Univariate regression comparing regurgitant jet area with cardiac output, stroke volume, systolic left ventricular pressure, pressure gradient, left ventricular/ left atrial pressure gradient, left atrial mean pressure, left atrial vwave pressure, systemic vascular resistance and maximal jet velocity showed poor correlation (0.08 < r < 0.53, SEE > 0.76 cm2).
Conclusions. This study demonstrates that color Doppler jet area has limited use for evaluating the severity of mitral regurgitation with eccentric jets.
☆ This study was supported in part by Grant HL 43287 from the National Heart, Lung, and Blood Institute, National Institutes of Health.
- Received September 17, 1993.
- Revision received March 2, 1994.
- Accepted March 31, 1994.