Diagnosis and quantification of aortic regurgitation by pulsed Doppler echocardiography in patients with mitral valve disease.

UNLABELLED

To test the ability of pulsed Doppler echocardiography (PDE) to detect and quantify aortic regurgitation (AR), 55 consecutive patients (14-74 years) with aortic and mitral valve disease were examined clinically and by echocardiography before cardiac catheterisation. The severity of AR was determined angiographically (I-IV) and compared to the extent of the regurgitant jet in the left ventricle measured by PDE. In 13 of 55 patients (3 with mitral stenosis, 3 with mitral incompetence, 3 with combined mitral lesions, 3 with aortic stenosis, one with aortic and mitral stenosis) neither angiography nor PDE showed AR (specificity 100%). Apart from 3 patients with poor echo quality PDE correctly detected AR in 39 of 42 patients (sensitivity 93%). Clinical examination (62%), mode M.mode (62%) and both methods combined (81%) were significantly less sensitive than PDE, especially in mild AR (P less than 0.008). The PDE degree of AR closely correlated with angiography (corrected contingency coefficient 0.91). Differentiation between AR III and IV was not possible. Mitral valve disease did not affect quantification of AR (n = 20 patients).

CONCLUSIONS

Pulsed Doppler echocardiography is better than auscultation and M-mode echocardiography in the diagnosis of aortic regurgitation, especially in grades I and II. PDE can reliably discriminate between three degrees of aortic regurgitation (I-III). Mitral valve disease does not affect quantification of aortic regurgitation by PDE.