The effects of regurgitant orifice size, chamber compliance, and systemic vascular resistance on aortic regurgitant velocity slope and pressure half-time.
The determinants of the aortic regurgitant velocity profile have been investigated using computer and in vitro simulations in which regurgitant orifice area, ventricular and aortic compliance, and systemic vascular resistance could be independently varied. In the study, regurgitant fraction was altered, either by changing the size of the regurgitant orifice or by holding the regurgitant orifice constant and changing chamber compliance or systemic vascular resistance. Upon increasing regurgitant fraction by increasing the size of the regurgitant orifice, the slope got steeper and the pressure half-time shortened, the response anticipated in current clinical practice. However, when the regurgitant orifice was kept constant and regurgitation fraction was increased by increasing the systemic vascular resistance or by increasing the compliance of the left ventricle, slope became less steep and pressure half-time lengthened. Multivariate analysis was used to quantify the relationship of regurgitant fraction to slope and pressure half-time. When orifice area was allowed to vary, slope was related directly (multiple r = 0.78, p less than 0.001) and half-time was related inversely (multiple r = 0.66, p less than 0.001) to regurgitant fraction. With the orifice area fixed, however, directionally opposite responses were seen; slope varied inversely (multiple r = 0.87, p less than 0.001), whereas half-time varied directly (multiple r = 0.88, p less than 0.001) with regurgitant fraction. This study suggests that the utility of the slope and pressure half-time of the regurgitant velocity tracing in clinical practice relates to their ability to discriminate regurgitant orifices of differing sizes.(ABSTRACT TRUNCATED AT 250 WORDS)
Griffin
B P
BP
Noninvasive Cardiac Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston 02114.
Flachskampf
F A
FA
Siu
S
S
Weyman
A E
AE
Thomas
J D
JD
D001022:Aortic Valve Insufficiency / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology; D003187:Compliance; D003198:Computer Simulation; D008955:Models, Cardiovascular; D008961:Models, Structural; D015999:Multivariate Analysis; D011312:Pressure; D014655:Vascular Resistance / Q000502:physiology*