title: Strategy for optimal aortic regurgitation quantification by Doppler echocardiography: agreement among different methods.
abstract: BACKGROUND
  Although different Doppler methods have been validated for aortic regurgitation quantification, the benefit of combining information from different methods has not been defined.
  
  
  METHODS
  Our study included 2 phases. In the initial phase (60 patients), Doppler parameters (jet width, short-axis jet area, apical jet area, regurgitant fraction from pulmonary and mitral flow, and deceleration slope) were correlated with angiography; range values for each severity grade were defined and intraobserver and interobserver and intermachine variability were studied. In the validation phase (158 patients), defined value ranges were prospectively tested and a strategy based on considering as the definitive severity grade that in which the two best methods agreed was tested.
  
  
  RESULTS
  Jet width had the best correlation with angiography (r = 0.91), and its ratio with the left ventricular outflow diameter did not improve the correlation (r = 0.85) and decreased reproducibility. Apical jet area and regurgitant fraction from pulmonary flow permitted acceptable quantification (r = 0.87 and 0.86, respectively) but with worse reproducibility. The other methods were not assessable in 20% to 30% of studies. Concordance with angiography decreased in jet width when the jet was eccentric (90% vs 77%, P <.01), in apical jet area when mitral valve disease was present (84% vs 65%, P <.02), and in short-axis jet area and regurgitant fraction from pulmonary flow with concomitant aortic stenosis (77% vs 44%, P <.002 and 77% vs 53%, P <.02, respectively). Agreement with angiography was very high (94 [95%] of 99) when severity grade coincided in both jet width and apical jet area. In 59 cases without concordance, regurgitant fraction from pulmonary flow was used as a third method. Overall, this strategy permitted concordance with angiography in 146 patients (92%).
  
  
  CONCLUSIONS
  Jet width is the best predictor in aortic regurgitation quantification by Doppler echocardiography. However, better results were obtained when a strategy based on concordance between jet width and another Doppler method was established, particularly when the jet was eccentric.
authors.affiliation: Servei de Cardiologia, Hospital General Universitari Vall D'Hebron, Barcelona, Spain. aevangelistam@meditex.es
authors.forename: A
authors.initials: A
authors.lastname: Evangelista
authors.forename: H G
authors.initials: HG
authors.lastname: del Castillo
authors.forename: F
authors.initials: F
authors.lastname: Calvo
authors.forename: G
authors.initials: G
authors.lastname: Permanyer-Miralda
authors.forename: C
authors.initials: C
authors.lastname: Brotons
authors.forename: J
authors.initials: J
authors.lastname: Angel
authors.forename: T
authors.initials: T
authors.lastname: González-Alujas
authors.forename: P
authors.initials: P
authors.lastname: Tornos
authors.forename: J
authors.initials: J
authors.lastname: Soler-Soler
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color / Q000706:statistics & numerical data*; D018619:Echocardiography, Doppler, Pulsed / Q000706:statistics & numerical data*; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity