Estimation of Aortic Regurgitation by Diastolic Pulse Wave Analysis

To test the hypothesis that the fall in supravalvular aortic diastolic pressure is relative to the severity of the regurgitant flow in aortic regurgitation, 27 patients with isolated aortic regurgitation, 23 patients with combined aortic regurgitation and stenosis, and 15 normal subjects were studied. Diastolic pulse pressure (pressure at the dicrotic notch minus pressure at end diastole) and the diastolic slope (line constructed through the dicrotic notch and end diastole) were measured. A highly significant correlation was found between the regurgitant flow in isolated aortic regurgitation and the diastolic pulse pressure when corrected for heart rate (r = 0.82, P <0.001). The diastolic slope related similarly to the regurgitant flow (r = 0.71, P < 0.001). There was no significant relationship, however, in the presence of combined aortic stenosis and regurgitation. Aortic pressure at end diastole and pulse pressure correlated poorly with either isolated aortic regurgitation or combined aortic valve disease. An electrical analog circuit was used to help explain these findings.