Color Doppler regurgitant jet area for evaluating eccentric mitral regurgitation: an animal study with quantified mitral regurgitation.
OBJECTIVE
The purpose of the present study was to rigorously evaluate the accuracy of the color Doppler jet area planimetry method for quantifying chronic mitral regurgitation.


BACKGROUND
Although the color Doppler jet area has been widely used clinically for evaluating the severity of mitral regurgitation, there have been no studies comparing the color jet area with a strictly quantifiable reference standard for determining regurgitant volume.


METHODS
In six sheep with surgically produced chronic mitral regurgitation, 24 hemodynamically different states were obtained. Maximal color Doppler jet area for each state was obtained with a Vingmed 750. Image data were directly transferred in digital format to a microcomputer. Mitral regurgitation was quantified by the peak and mean regurgitant flow rates, regurgitant stroke volumes and regurgitant fractions determined using mitral and aortic electromagnetic flow probes.


RESULTS
Mean regurgitant volumes varied from 0.19 to 2.4 liters/min (mean [+/- SD] 1.2 +/- 0.59), regurgitant stroke volumes from 1.8 to 29 ml/beat (mean 11 +/- 6.2), peak regurgitant volumes from 1.0 to 8.1 liters/min (mean 3.5 +/- 2.1) and regurgitant fractions from 8.0% to 54% (mean 29 +/- 12%). Twenty-two of 24 jets were eccentric. Simple linear regression analysis between maximal color jet areas and peak and mean regurgitant flow rates, regurgitant stroke volumes and regurgitant fractions showed correlation, with r = 0.68 (SEE 0.64 cm2), r = 0.63 (SEE 0.67 cm2), r = 0.63 (SEE 0.67 cm2) and r = 0.58 (SEE 0.71 cm2), respectively. Univariate regression comparing regurgitant jet area with cardiac output, stroke volume, systolic left ventricular pressure, pressure gradient, left ventricular/left atrial pressure gradient, left atrial mean pressure, left atrial v wave pressure, systemic vascular resistance and maximal jet velocity showed poor correlation (0.08 < r < 0.53, SEE > 0.76 cm2).


CONCLUSIONS
This study demonstrates that color Doppler jet area has limited use for evaluating the severity of mitral regurgitation with eccentric jets.
Shiota
T
T
Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, Portland 97201-3181.
Jones
M
M
Teien
D
D
Yamada
I
I
Passafini
A
A
Knudson
O
O
Sahn
D J
DJ
D000818:Animals; D001021:Aortic Valve / Q000503:physiopathology; D001794:Blood Pressure; D002908:Chronic Disease; D015150:Echocardiography, Doppler / Q000379:methods / Q000592:standards; D055590:Electromagnetic Phenomena; D007091:Image Processing, Computer-Assisted; D008943:Mitral Valve / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015999:Multivariate Analysis; D015588:Observer Variation; D011237:Predictive Value of Tests; D012015:Reference Standards; D012039:Regional Blood Flow; D012044:Regression Analysis; D012212:Rheology; D012756:Sheep; D013318:Stroke Volume