Estimation of aortic regurgitation by diastolic pulse wave analysis.

SUMMARY 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. Angiocardiography Rheumatic heart disease SEVERAL TECHNICS HAVE been developed for the quantitative evaluation of aortic regurgitation.'-9 All such technics described to date have required specialized equipment, are relatively complex, or are only semiquantitative. Most of these methods have not been widely used because of these difficulties. The angiocardiographic methodv°0 for the determination of regurgitant flow has been useful in the clinical evaluation of patients, but a simpler, more widely available method is needed. This study was undertaken to test the hypothesis that the detailed analysis of the diastolic portion of the central aortic pressure would be useful in estimating severity of aortic regurgitation. The results of this analysis are compared to the regurgitant flow as Circulatory electrical analog independently measured from biplane angio-cardiograms. Methods Fifty cases of aortic regurgitation, 23 of which had combined aortic stenosis, and 15 controls were selected from our catheterization files. All had complete right and left heart catheterization with clear, standardized supravalvular aortic and left ventricular pressure tracings. Pressures were measured using a fluid-filled 8 F, 100 cm Gensini catheter attached to a Statham P23Db transducer and recorded on an Electronics for Medicine or Honeywell optical recorder. This system has been tested and shown to possess less than 5% distortion to 8 to 10 Hz. Cardiac output was measured using the direct Fick method. In the aortic regurgitation groups, all had high quality left ventricular biplane angiocardiograms. Mitral regurgitation was excluded in …