Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation

Sharon C. Reimold, Stephan E. Maier, Kirsten E. Fleischmann, Mohammed Khatri, David Piwnica-Worms, Ron Kikinis, Richard T. Lee

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Abstract

Background: The effective aortic regurgitant orifice area varies with aortic pressure in animal models of acute aortic regurgitation. The purpose of this study was to determine whether the aortic regurgitant orifice area changes during diastole in patients with chronic aortic regurgitation. Methods and Results: Two-dimensional and Doppler echocardiography were performed immediately before and after magnetic resonance velocity mapping using a cine phase contrast sequence in 17 patients with chronic aortic regurgitation. ECG-gated continuous-wave Doppler velocity time integrals and magnetic resonance flow rates were measured 16 times per cardiac cycle. The mean aortic regurgitant orifice area (centimeters squared) was calculated by the continuity equation. The regurgitant orifice area was also determined for each diastolic acquisition interval. Changes in the regurgitant orifice area during diastole were modeled using an asymptotic exponential decay model to determine the static and dynamic components of the orifice. The regurgitant orifice area increased directly with regurgitant fraction (y[cm2]=0.0072[cm2/%]*x[%]-0.0409[cm2]; r=.86, P<.0001). In 15 of 17 (88%) patients, the regurgitant orifice area decreased during diastole. The dynamic component of the regurgitant orifice area decreased with increasing regurgitant fraction (y[%]=-0.98x[%]+96.9[%]; r=-.90, P<.0001). There were no significant differences in heart rate, systolic or diastolic blood pressures, or continuous-wave Doppler velocity time integrals measured before or after the magnetic resonance examination. Conclusions: The effective regurgitant orifice area decreases during diastole in patients with chronic aortic regurgitation. This phenomenon should be considered when evaluating aortic regurgitant severity.

Original languageEnglish (US)
Pages (from-to)2085-2092
Number of pages8
JournalCirculation
Volume89
Issue number5
StatePublished - May 1994

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Diastole
Aortic Valve Insufficiency
Magnetic Resonance Spectroscopy
Blood Pressure
Doppler Echocardiography
Arterial Pressure
Electrocardiography
Animal Models
Heart Rate

Keywords

  • aorta
  • echocardiography
  • magnetic resonance imaging
  • regurgitation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Reimold, S. C., Maier, S. E., Fleischmann, K. E., Khatri, M., Piwnica-Worms, D., Kikinis, R., & Lee, R. T. (1994). Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation. Circulation, 89(5), 2085-2092.

Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation. / Reimold, Sharon C.; Maier, Stephan E.; Fleischmann, Kirsten E.; Khatri, Mohammed; Piwnica-Worms, David; Kikinis, Ron; Lee, Richard T.

In: Circulation, Vol. 89, No. 5, 05.1994, p. 2085-2092.

Research output: Contribution to journalArticle

Reimold, SC, Maier, SE, Fleischmann, KE, Khatri, M, Piwnica-Worms, D, Kikinis, R & Lee, RT 1994, 'Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation', Circulation, vol. 89, no. 5, pp. 2085-2092.
Reimold SC, Maier SE, Fleischmann KE, Khatri M, Piwnica-Worms D, Kikinis R et al. Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation. Circulation. 1994 May;89(5):2085-2092.
Reimold, Sharon C. ; Maier, Stephan E. ; Fleischmann, Kirsten E. ; Khatri, Mohammed ; Piwnica-Worms, David ; Kikinis, Ron ; Lee, Richard T. / Dynamic nature of the aortic regurgitant orifice area during diastole in patients with chronic aortic regurgitation. In: Circulation. 1994 ; Vol. 89, No. 5. pp. 2085-2092.
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abstract = "Background: The effective aortic regurgitant orifice area varies with aortic pressure in animal models of acute aortic regurgitation. The purpose of this study was to determine whether the aortic regurgitant orifice area changes during diastole in patients with chronic aortic regurgitation. Methods and Results: Two-dimensional and Doppler echocardiography were performed immediately before and after magnetic resonance velocity mapping using a cine phase contrast sequence in 17 patients with chronic aortic regurgitation. ECG-gated continuous-wave Doppler velocity time integrals and magnetic resonance flow rates were measured 16 times per cardiac cycle. The mean aortic regurgitant orifice area (centimeters squared) was calculated by the continuity equation. The regurgitant orifice area was also determined for each diastolic acquisition interval. Changes in the regurgitant orifice area during diastole were modeled using an asymptotic exponential decay model to determine the static and dynamic components of the orifice. The regurgitant orifice area increased directly with regurgitant fraction (y[cm2]=0.0072[cm2/{\%}]*x[{\%}]-0.0409[cm2]; r=.86, P<.0001). In 15 of 17 (88{\%}) patients, the regurgitant orifice area decreased during diastole. The dynamic component of the regurgitant orifice area decreased with increasing regurgitant fraction (y[{\%}]=-0.98x[{\%}]+96.9[{\%}]; r=-.90, P<.0001). There were no significant differences in heart rate, systolic or diastolic blood pressures, or continuous-wave Doppler velocity time integrals measured before or after the magnetic resonance examination. Conclusions: The effective regurgitant orifice area decreases during diastole in patients with chronic aortic regurgitation. This phenomenon should be considered when evaluating aortic regurgitant severity.",
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AU - Maier, Stephan E.

AU - Fleischmann, Kirsten E.

AU - Khatri, Mohammed

AU - Piwnica-Worms, David

AU - Kikinis, Ron

AU - Lee, Richard T.

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N2 - Background: The effective aortic regurgitant orifice area varies with aortic pressure in animal models of acute aortic regurgitation. The purpose of this study was to determine whether the aortic regurgitant orifice area changes during diastole in patients with chronic aortic regurgitation. Methods and Results: Two-dimensional and Doppler echocardiography were performed immediately before and after magnetic resonance velocity mapping using a cine phase contrast sequence in 17 patients with chronic aortic regurgitation. ECG-gated continuous-wave Doppler velocity time integrals and magnetic resonance flow rates were measured 16 times per cardiac cycle. The mean aortic regurgitant orifice area (centimeters squared) was calculated by the continuity equation. The regurgitant orifice area was also determined for each diastolic acquisition interval. Changes in the regurgitant orifice area during diastole were modeled using an asymptotic exponential decay model to determine the static and dynamic components of the orifice. The regurgitant orifice area increased directly with regurgitant fraction (y[cm2]=0.0072[cm2/%]*x[%]-0.0409[cm2]; r=.86, P<.0001). In 15 of 17 (88%) patients, the regurgitant orifice area decreased during diastole. The dynamic component of the regurgitant orifice area decreased with increasing regurgitant fraction (y[%]=-0.98x[%]+96.9[%]; r=-.90, P<.0001). There were no significant differences in heart rate, systolic or diastolic blood pressures, or continuous-wave Doppler velocity time integrals measured before or after the magnetic resonance examination. Conclusions: The effective regurgitant orifice area decreases during diastole in patients with chronic aortic regurgitation. This phenomenon should be considered when evaluating aortic regurgitant severity.

AB - Background: The effective aortic regurgitant orifice area varies with aortic pressure in animal models of acute aortic regurgitation. The purpose of this study was to determine whether the aortic regurgitant orifice area changes during diastole in patients with chronic aortic regurgitation. Methods and Results: Two-dimensional and Doppler echocardiography were performed immediately before and after magnetic resonance velocity mapping using a cine phase contrast sequence in 17 patients with chronic aortic regurgitation. ECG-gated continuous-wave Doppler velocity time integrals and magnetic resonance flow rates were measured 16 times per cardiac cycle. The mean aortic regurgitant orifice area (centimeters squared) was calculated by the continuity equation. The regurgitant orifice area was also determined for each diastolic acquisition interval. Changes in the regurgitant orifice area during diastole were modeled using an asymptotic exponential decay model to determine the static and dynamic components of the orifice. The regurgitant orifice area increased directly with regurgitant fraction (y[cm2]=0.0072[cm2/%]*x[%]-0.0409[cm2]; r=.86, P<.0001). In 15 of 17 (88%) patients, the regurgitant orifice area decreased during diastole. The dynamic component of the regurgitant orifice area decreased with increasing regurgitant fraction (y[%]=-0.98x[%]+96.9[%]; r=-.90, P<.0001). There were no significant differences in heart rate, systolic or diastolic blood pressures, or continuous-wave Doppler velocity time integrals measured before or after the magnetic resonance examination. Conclusions: The effective regurgitant orifice area decreases during diastole in patients with chronic aortic regurgitation. This phenomenon should be considered when evaluating aortic regurgitant severity.

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KW - echocardiography

KW - magnetic resonance imaging

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