REGURGITATION Assessment and follow - up of patients with aortic

The purpose of this study was to determine the value and limitations of an updated Doppler echocardiographic measurement of the aortic regurgitant fraction derived from the comparison of forward and reverse flows in the aortic arch. The method was based on the improvements in sampling and displaying Doppler frequencies and blood velocities provided by pulsed-emission, twodimensional location, and spectral analysis and on an account for variations of aortic diameter through an M mode record of the aortic arch. Relevant statistical comparisons were performed between simultaneous noninvasive and invasive determinations of the regurgitant fraction in a group of 30 patients with aortic regurgitation (group 1) and between simultaneous noninvasive and invasive measurements of variations of the regurgitant fraction induced by atrial pacing or vasodilator administration in 12 patients of this group. The two basal determinations were closely correlated (r = .90). The invasive regurgitant fraction ranged from 0% to 80%. The standard error of the Doppler estimate was 8.8% in group I as a whole and was only 6% in a subgroup of 20 patients with a high systolic aortic flow pattern, defined as both peak velocity above 0.8 m/sec and duration of systolic flow above 0.24 sec. This pattern was present in almost all (19/22) patients in whom the aortic regurgitation was more than moderate by invasive criterion (regurgitant fraction above 40%). The standard error of the Doppler estimate of variations of the regurgitant fraction was only 6.6%. Among 100 additional patients with aortic regurgitation (group 1I), only 12 had no pandiastolic reverse flow in the arch, and their regurgitation was always mild at aortographic examination. Among 100 patients without aortic regurgitation (group III) four had a pandiastolic reverse flow in the arch and each had a left-to-right shunt issued from the aorta at the invasive study. The false-negative and false-positive diagnoses of aortic regurgitation on aortic arch records were all corrected by the Doppler sampling beneath the aortic valve. Provided that left ventricular sampling confirms the regurgitation and that aortic sampling displays the high systolic flow pattern, the Doppler measurement of the regurgitant fraction in the aortic arch is remarkably suited to the assessment and follow-up of patients with aortic regurgitation. Circulation 72, No. 4, 819-824, 1985. ECHOCARDIOGRAPHIC measurements of left ventricular dimensions contribute to the assessment and follow-up of patients with aortic regurgitation,' 2 although their prognostic value is still controversial.3 Noninvasive quantitation of the magnitude of the reFrom Services d'Explorations Fonctionnelles et de Cardiologie. H6pital Bichat, and Unite de Recherche INSERM 251, Faculte Xavier Bichat, Paris, France. Supported in part by grants from CNAMTS and Federation de Cardiologie. Address for correspondence: Thierry Touche, M.D.. Service d'Explorations Fonctionnelles, H6pital Bichat. 46 rue Henri Huchard, 75018 Paris, France. Received July 20, 1984; revision accepted June 13, 1985. Presented in part at the 56th Scientific Sessions of the American Heart Association, November 1983. Anaheim, CA. gurgitation would improve the assessment of these patients and could provide important additional data regarding the prognosis. Boughner4 in 1975 measured the aortic regurgitant fraction in the aortic arch by means of a continuous-wave Doppler instrument, but the measurement was difficult and even impossible in some patients because of interference with venous flows present along the ultrasonic beam. Since the introduction of pulsed-wave Doppler, which provides range resolution along the beam and can be performed under two-dimensional location, numerous indexes have been proposed based either on flow comparisons in the aorta5-7 or on mappings of the regurgitant jet in the left ventricle.81-0 However, these new indexes were Vol. 72, No. 4, October 1985 819 by gest on N ovem er 2, 2017 http://ciajournals.org/ D ow nladed from