Correlation of echo-Doppler aortic valve regurgitation index with angiographic aortic regurgitation severity
Cedars-Sinai Medical Center, Los Ángeles, California, United StatesThe American Journal of Cardiology (Impact Factor: 3.28). 10/2003; 92(5):634-5. DOI: 10.1016/S0002-9149(03)00743-4
We assessed aortic regurgitation (AR) severity by utilizing multiple echo-Doppler variables in comparison with AR severity by aortic root angiography. Patients were divided into 3 groups: mild, moderate, and severe. An AR index (ARI) was developed, comprising 5 echocardiographic parameters: ratio of color AR jet height to left ventricular outlet flow diameter, AR signal density from continuous-wave Doppler, pressure half-time, left ventricular end-diastolic diameter, and aortic root diameter. There was a strong correlation between AR severity by angiography and the calculated echo-Doppler ARI (r = 0.84, p = 0.0001). As validated by aortic angiography, the ARI is an accurate reflection of AR severity.
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ABSTRACT: No single precise qualitative method is recommended for evaluating the severity of aortic regurgitation (AR). Quantitative methods for AR assessment are, typically, cumbersome and time-consuming. The purpose of this study was to develop a more comprehensive method for predicting the severity of AR. In all, 79 patients with normal left ventricular systolic function and at least mild AR were included in this prospective study. The standard references for evaluating AR severity were quantitative methods. The AR index consisted of 5 echocardiographic parameters: jet width ratio, vena contracta width, pressure half-time, jet density, and diastolic flow reversal in the descending aorta. Each parameter was scored on a 3-point scale from 1 to 3. The AR index was calculated as the sum of each score divided by the number of parameters. Thus, an increasing AR index score from 1 to 3 was indicative of increasing regurgitation. The study demonstrated that the numeric value of AR index increased proportionately to the quantitative grading of AR severity, and proved to be an accurate predictor for AR severity. A 1.8 threshold for the AR index offered a high level of sensitivity and negative predictive value for severe AR. The possibility of missing severe AR was low with AR index less than 1.8. A 2.6 threshold for the AR index provided high specificity and positive predictive value for severe AR. The possibility of diagnosing severe AR was extremely high with AR index of 2.6 or more. AR index provided a more comprehensive method for predicting the degree of AR severity in this study. We suggest that the AR index should be considered for any evaluation of the severity of AR.
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ABSTRACT: As medical professionals, we strive to provide high-quality examinations that provide the information needed for physicians to make definitive diagnoses for their patients. The quality of examinations performed is consistently monitored and analyzed for correlation with other diagnostic modalities. The following case puzzled cardiac sonographers, pulmonologists, and cardiologists from several different institutions. Due to the discrepancies between echocardiographic and catheterization results, the patient underwent five echocardiograms, three of which were performed at the same institution as the two right heart catheterizations. Cardiologists and sonographers have trusted the modified Bernoulli’s equation to provide accurate and reproducible echocardiographic pressures. However, this case proved puzzling when the catheterization pressures were normal and the echocardiogram reported high pressures indicating significant pulmonary hypertension.
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