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Quantitative assessment of aortic regurgitation by Doppler echocardiography: Usefulness of the comparison of aortic and pulmonary flows
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International audience. AimsPatients with significant (3+/4+) aortic regurgitation (AR) require careful monitoring or valve surgery. We soughtto evaluate the diagnostic performance of aortic and pulmonary flow comparison in identifying patients with significant AR, by echocardiography. MethodTwo hundred forty-six patients with more than trivial AR were prospectively enrolled from three centers. Aortic regurgitation (AR) severity was assessed by an expert using the currently recommended integrative approach. Aortic and pulmonary flows were independently assessed by another investigator to calculate the regurgitant fraction (RF), the aortic to pulmonary flow ratio (Qao/Qp) and the aortic to pulmonary velocity-time integral (VTIao/VTIp) ratio. The control group consisted of 195 patients without AR. ResultsA significant correlation was observed between AR grading and RF (r=.82, P<.0001) and Qao/Qp (r=.81, P<.0001), but the correlation was modest for VTIao/VTIp ratio (r=.63; P<.0001). The accuracy of RF and Qao/Qp ratio to identify patients with significant AR was excellent (0.96 and 0.95, respectively), but was significantly lower for VTIao/VTIp ratio at 0.82. A RF>40% indicated grade 3 or 4 AR with a sensitivity of 83% and a specificity of 93%. A Qao/Qp ratio>1.6 indicated grade 3 or 4 AR with a sensitivity of 88% and a specificity of 89%. The VTIao/VTIp ratio was not helpful in identifying patients with significant AR, as a wide overlap was found between 1+/2+ and 3+/4+ patients. ConclusionRegurgitant fraction (RF) and Qao/Qp are helpful in identifying significant AR. The assessment of Doppler aortic/pulmonary flow should be incorporated in the comprehensive evaluation of AR.
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