Severity of aortic regurgitation assessed by area of vena contracta: a clinical two-dimensional and three-dimensional color Doppler imaging study.
BACKGROUND
Quantitation of aortic regurgitation (AR) using two-dimensional (2D) echocardiography, including vena contracta width (VCW) measurement, is still challenging. Three-dimensional (3D) echocardiography can directly measure the vena contracta area (VCA), regardless of the rheological characteristics. We intended to assess the possibility of 3D vena contracta area (3DVCA) as well as 2D vena contracta area (2DVCA) in the assessment of AR severity.


METHODS
Sixty-one patients with AR [17 female (32.7%); mean age: 74.0 ± 10.1 years] underwent 2D and 3D color Doppler echocardiography. Using conventional 2D color Doppler imaging, we measured VCW, 2DVCA, regurgitant volume (RV), and effective regurgitant orifice area (EROA). We also measured 3DVCA manually off-line from 3D full-volume color Doppler datasets for reference. Comprehensive 2D and 3D data on AR severity were successfully obtained from 52 of the 61 (85.2%) patients.


RESULTS
Significant correlations existed between 2DVCA and EROA (r = 0.89; p < 0.001). The cut-off 2DVCA for grading severe AR was 34 mm2 (area under curve: 0.95; sensitivity: 78%; specificity: 95%). Significant correlations existed between 3DVCA and EROA (r = 0.89; p < 0.001). The cut-off 3DVCA for grading severe AR was 32 mm2 (area under curve: 0.96; sensitivity: 89%; specificity: 98%). Significant correlations existed between 2DVCA and 3DVCA (r = 0.97; p < 0.001).


CONCLUSIONS
Two-dimensional, as well as three dimensional, vena contracta area measurement is a simple technique suitable for clinical use during comprehensive Doppler echocardiographic AR assessment.
Department of Cardiology, Matsue City Hospital, 32-1 Nohira-cho, Matsue, Japan. heart@matsue-cityhospital.jp.
Hirotomo
H
Sato
Department of Cardiology, Matsue City Hospital, 32-1 Nohira-cho, Matsue, Japan. ohtatvc@gmail.com.
Tetsuro
T
Ohta
Department of Cardiology, Matsue City Hospital, 32-1 Nohira-cho, Matsue, Japan. heart@matsue-cityhospital.jp.
Kimiko
K
Hiroe
Department of Cardiology, Matsue City Hospital, 32-1 Nohira-cho, Matsue, Japan. heart@matsue-cityhospital.jp.
Seiji
S
Okada
Department of Cardiology, Matsue City Hospital, 32-1 Nohira-cho, Matsue, Japan. heart@matsue-cityhospital.jp.
Koji
K
Shimizu
Department of Cardiology, Matsue City Hospital, 32-1 Nohira-cho, Matsue, Japan. heart@matsue-cityhospital.jp.
Rinji
R
Murakami
Division of Cardiology, Department of Internal Medicine, Shimane University Faulty of Medicine, Izumo, Japan. kaz@med.shimane-u.ac.jp.
Kazuaki
K
Tanabe
D000368:Aged; D000465:Algorithms; D001011:Aorta / Q000000981:diagnostic imaging*; D001021:Aortic Valve / Q000000981:diagnostic imaging; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index