title: Intensity of murmurs correlates with severity of valvular regurgitation.
abstract: OBJECTIVE
  To evaluate the relationship between the intensity of murmurs and severity of mitral and aortic regurgitation.
  
  
  METHODS
  Consecutive patients with chronic isolated aortic (n = 40) or mitral (n = 170) regurgitation undergoing echocardiographic quantitation of regurgitation between 1990 and 1991 were studied. Regurgitant volume and fraction were measured using two simultaneous methods (quantitative Doppler echocardiography and quantitative two-dimensional echocardiography); the intensity of the regurgitant murmur (grade 0 to 6) was noted by physicians unaware of the study.
  
  
  RESULTS
  Correlations between murmur intensity and regurgitant volume and fraction were good in aortic regurgitation (r = .60 and r = .67, respectively; P < 0.001) and mitral regurgitation (r = .64 and r = .67, respectively; P < 0.001) but weaker (r = .47 and r = .45, respectively) in the subset of mitral regurgitation of ischemic or functional cause. Murmur intensity grades > or = 3 for aortic regurgitation and > or = 4 for mitral regurgitation predicted severe regurgitation (regurgitant fraction > or = 40%) in 71% and 91% of patients, respectively. Murmur grades < or = 1 for aortic regurgitation and < or = 2 for mitral regurgitation predicted "not severe" regurgitation in 100% and 88% of patients, respectively. Murmur grades 2 for aortic regurgitation and 3 for mitral regurgitation were not correlated to degree of regurgitation. The severity of regurgitation was the most powerful determinant of intensity of murmur.
  
  
  CONCLUSIONS
  Murmur intensity correlates well with the degree of chronic organic aortic and mitral regurgitation, and can be used as a predictor of regurgitation severity and as a simple guideline for diagnostic testing in these patients.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: V A
authors.initials: VA
authors.lastname: Desjardins
authors.forename: M
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: A J
authors.initials: AJ
authors.lastname: Tajik
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D006337:Heart Murmurs / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012720:Severity of Illness Index