A simplified, practical approach to assessment of severity of mitral regurgitation by Doppler color flow imaging with proximal convergence: validation with concomitant cardiac catheterization.
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.
Chaliki
H P
HP
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Scottsdale, Arizona, USA.
Nishimura
R A
RA
Enriquez-Sarano
M
M
Reeder
G S
GS
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