Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta

Shelley A. Hall, M. Elizabeth Brickner, Duwayne L. Willett, Waleed N. Irani, Imran Afridi, Paul A. Grayburn

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Abstract

Background: Although Doppler color flow mapping is widely used to assess the severity of mitral regurgitation (MR), a simple, accurate, and quantitative marker of MR by color flow mapping remains elusive. We hypothesized that vena contracta width by color flow mapping would accurately predict the severity of MR. Methods and Results: We studied 80 patients with MR. Vena contracta width was measured in multiple views with zoom mode and nonstandard angulation to optimize its visualization. Flow volumes across the left ventricular outflow tract and mitral annulus were calculated by pulsed- Doppler technique to determine regurgitant volume. Effective regurgitant orifice area was calculated by dividing the regurgitant volume by the continuous-weave Doppler velocity-time integral of the MR jet. The cause of MR was ischemia in 24, dilated cardiomyopathy in 34, mitral valve prolapse in 12, endocarditis in 2, rheumatic disease in 2, mitral annular calcification in 1, and uncertain in 5. Regurgitant volumes ranged from 2 to 191 mL. Regurgitant orifice area ranged from 0.01 to 1.47 cm 2. Single-plane vena contracta width from the parasternal long-axis view correlated well with regurgitant volume (r = .85, SEE = 20 mL) and regurgitant orifice area (r = .86, SEE = 0.15 cm 2). Biplane vena contracta width from apical views correlated well with regurgitant volume (r = .85, SEE = 19 mL) and regurgitant orifice area (r = .88, SEE = 0.14 cm 2). A biplane vena contracta width ≤0.5 cm was always associated with a regurgitant volume >60 mL and a regurgitant orifice area >0.4 cm 2. A biplane vena contracta width ≤0.3 cm predicted a regurgitant volume <60 mL and a regurgitant orifice area <0.4 cm 2 in 24 of 29 patients. No other parameter, including jet area, left atrial size, pulmonary flow reversal, or semiquantitative MR grade, correlated significantly with regurgitant volume or regurgitant orifice area in a multivariate analysis. Conclusions: Our results demonstrate that careful color flow mapping of the vena contracta of the MR jet provides a simple quantitative assessment of MR that correlates well with quantitative Doppler techniques.

Original languageEnglish (US)
Pages (from-to)636-642
Number of pages7
JournalCirculation
Volume95
Issue number3
StatePublished - 1997

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Mitral Valve Insufficiency
Color
Mitral Valve Prolapse
Dilated Cardiomyopathy
Endocarditis
Rheumatic Diseases
Multivariate Analysis
Ischemia
Lung

Keywords

  • echocardiography
  • mapping
  • regurgitation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. / Hall, Shelley A.; Brickner, M. Elizabeth; Willett, Duwayne L.; Irani, Waleed N.; Afridi, Imran; Grayburn, Paul A.

In: Circulation, Vol. 95, No. 3, 1997, p. 636-642.

Research output: Contribution to journalArticle

Hall, Shelley A. ; Brickner, M. Elizabeth ; Willett, Duwayne L. ; Irani, Waleed N. ; Afridi, Imran ; Grayburn, Paul A. / Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. In: Circulation. 1997 ; Vol. 95, No. 3. pp. 636-642.
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T1 - Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta

AU - Hall, Shelley A.

AU - Brickner, M. Elizabeth

AU - Willett, Duwayne L.

AU - Irani, Waleed N.

AU - Afridi, Imran

AU - Grayburn, Paul A.

PY - 1997

Y1 - 1997

N2 - Background: Although Doppler color flow mapping is widely used to assess the severity of mitral regurgitation (MR), a simple, accurate, and quantitative marker of MR by color flow mapping remains elusive. We hypothesized that vena contracta width by color flow mapping would accurately predict the severity of MR. Methods and Results: We studied 80 patients with MR. Vena contracta width was measured in multiple views with zoom mode and nonstandard angulation to optimize its visualization. Flow volumes across the left ventricular outflow tract and mitral annulus were calculated by pulsed- Doppler technique to determine regurgitant volume. Effective regurgitant orifice area was calculated by dividing the regurgitant volume by the continuous-weave Doppler velocity-time integral of the MR jet. The cause of MR was ischemia in 24, dilated cardiomyopathy in 34, mitral valve prolapse in 12, endocarditis in 2, rheumatic disease in 2, mitral annular calcification in 1, and uncertain in 5. Regurgitant volumes ranged from 2 to 191 mL. Regurgitant orifice area ranged from 0.01 to 1.47 cm 2. Single-plane vena contracta width from the parasternal long-axis view correlated well with regurgitant volume (r = .85, SEE = 20 mL) and regurgitant orifice area (r = .86, SEE = 0.15 cm 2). Biplane vena contracta width from apical views correlated well with regurgitant volume (r = .85, SEE = 19 mL) and regurgitant orifice area (r = .88, SEE = 0.14 cm 2). A biplane vena contracta width ≤0.5 cm was always associated with a regurgitant volume >60 mL and a regurgitant orifice area >0.4 cm 2. A biplane vena contracta width ≤0.3 cm predicted a regurgitant volume <60 mL and a regurgitant orifice area <0.4 cm 2 in 24 of 29 patients. No other parameter, including jet area, left atrial size, pulmonary flow reversal, or semiquantitative MR grade, correlated significantly with regurgitant volume or regurgitant orifice area in a multivariate analysis. Conclusions: Our results demonstrate that careful color flow mapping of the vena contracta of the MR jet provides a simple quantitative assessment of MR that correlates well with quantitative Doppler techniques.

AB - Background: Although Doppler color flow mapping is widely used to assess the severity of mitral regurgitation (MR), a simple, accurate, and quantitative marker of MR by color flow mapping remains elusive. We hypothesized that vena contracta width by color flow mapping would accurately predict the severity of MR. Methods and Results: We studied 80 patients with MR. Vena contracta width was measured in multiple views with zoom mode and nonstandard angulation to optimize its visualization. Flow volumes across the left ventricular outflow tract and mitral annulus were calculated by pulsed- Doppler technique to determine regurgitant volume. Effective regurgitant orifice area was calculated by dividing the regurgitant volume by the continuous-weave Doppler velocity-time integral of the MR jet. The cause of MR was ischemia in 24, dilated cardiomyopathy in 34, mitral valve prolapse in 12, endocarditis in 2, rheumatic disease in 2, mitral annular calcification in 1, and uncertain in 5. Regurgitant volumes ranged from 2 to 191 mL. Regurgitant orifice area ranged from 0.01 to 1.47 cm 2. Single-plane vena contracta width from the parasternal long-axis view correlated well with regurgitant volume (r = .85, SEE = 20 mL) and regurgitant orifice area (r = .86, SEE = 0.15 cm 2). Biplane vena contracta width from apical views correlated well with regurgitant volume (r = .85, SEE = 19 mL) and regurgitant orifice area (r = .88, SEE = 0.14 cm 2). A biplane vena contracta width ≤0.5 cm was always associated with a regurgitant volume >60 mL and a regurgitant orifice area >0.4 cm 2. A biplane vena contracta width ≤0.3 cm predicted a regurgitant volume <60 mL and a regurgitant orifice area <0.4 cm 2 in 24 of 29 patients. No other parameter, including jet area, left atrial size, pulmonary flow reversal, or semiquantitative MR grade, correlated significantly with regurgitant volume or regurgitant orifice area in a multivariate analysis. Conclusions: Our results demonstrate that careful color flow mapping of the vena contracta of the MR jet provides a simple quantitative assessment of MR that correlates well with quantitative Doppler techniques.

KW - echocardiography

KW - mapping

KW - regurgitation

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