title: A simplified, practical approach to assessment of severity of mitral regurgitation by Doppler color flow imaging with proximal convergence: validation with concomitant cardiac catheterization.
abstract: OBJECTIVE
  To compare the proximal convergence method for quantification of mitral regurgitation with findings on concomitant left ventriculography.
  
  
  METHODS
  In 41 patients (22 men and 19 women, 63 +/- 13 years of age), mitral regurgitation was evaluated concomitantly by Doppler color flow jet area, proximal convergence method, and left ventriculography. A simplified measurement of the proximal convergence, consisting of the aliasing radius and velocity of the proximal isosurface (r2 x V), was used.
  
  
  RESULTS
  Angiographic grade correlated well with the proximal convergence method (r2 x V) but had poor correlation with the Doppler color flow jet area method. All patients with a proximal convergence flow rate of less than 10 cm3/s had grade 1 or 2 mitral regurgitation, whereas patients with a proximal convergence flow rate of more than 20 cm3/s had grade 3 or 4 mitral regurgitation. The severity of mitral regurgitation was indeterminate in patients with proximal convergence flow rates from 10 to 20 cm3/s.
  
  
  CONCLUSIONS
  Doppler color flow jet area correlates poorly with angiographic grade of mitral regurgitation. A simplified proximal convergence method is useful for separating grade 3 and 4 from grade 1 and 2 mitral regurgitation in most patients. A group of patients with indeterminate severity of mitral regurgitation remains, however, in whom further assessment is necessary.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Scottsdale, Arizona, USA.
authors.forename: H P
authors.initials: HP
authors.lastname: Chaliki
authors.forename: R A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: M
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: G S
authors.initials: GS
authors.lastname: Reeder
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index