Table 3

Multiparametric assessment of regurgitation

2D colour Doppler jet area Embedded Image Easy screening for mild or severe
If narrow, specific for mild
Overestimates if transient
Underestimates if
  • Wall hugging.

  • Eccentric.

Variable a/c to
  • Machine settings.

  • Haemodynamics.

Narrow origin, smallWide origin, large
MR >50% MR/LA area
AR>65% jet width/LVOT
2D colour Doppler vena contracta width Embedded Image Easy
Good for mild or severe
Independent of flow and pressure
Useful in eccentric jets
Marker for ROA
Multiple jets
Overestimates if transient
Must be measured when US is perpendicular
<3 mmMR >7 mm
AR >6 mm
2D colour Doppler flow convergence Embedded Image Easy
If absent, specific for mild
Multiple jets
  • Overestimates if transient.

  • Non-hemispheric.

Underestimates if
  • Wall hugging.

  • Eccentric.

If no flow convergence can be seen>10 mm if Nyquist 30–40 cm/s
3D colour Doppler vena contracta area Embedded Image Useful if:
Multiple jets
If PISA non-hemispheric
Limits of temporal and spatial resolution 3D CF
Overestimates if transient
CW Doppler density Embedded Image Easy
Dense triangular shape specific for severe MR
Gain dependent
Underestimates eccentric
2D colour Doppler PISA Embedded Image Quantitative:
EROA mm2
RVol mls
RF %
Overestimates if
Less accurate in functional MR
MR EROA<20 mm
AR EROA<10 mm
RVol<30 mL
Primary MR>40 mm
SIMR>20 mm
AR EROA>30 mm
RVol>60 mL
Pulse Doppler Embedded Image Quantitative:
RVol mL
RF %
Can be used in
Multiple jets
Wide confidence limits
Not useful if multiple valve disease
Primary MR RVol <30 mL
MR RF <30%
AR RVol <30 mL
AR RF <30%
Primary MR RVol >60 mL
MR RF >50%
Secondary MR RVol >30 mL
AR RVol >60 mL
AR RF >50%
CMR flow quantification Embedded Image Accurate quantification of flow
Not affected by irregular, eccentric, multiple or dynamic jets
Easy to measure
Accurate measures often require good correction of background flow offset error
Slight tendency for AR quantities to be underestimated
Not available in all hospitals
MR Vol <30 mL
MR RF <20%
AR RF <15%
MR Vol>60 mL
MR RF >40%
AR RF >35%–40%
Holodiastolic descending aorta flow reversal
MR only
Pulse Doppler MV inflow Embedded Image Easy
Altered by LA/LV pressure gradient
A wave dominant
Specific for mild MR
E Vmax >1.5 m/s
Pulse Doppler MV inflow/LVOT vti ratio Embedded Image EasyAF
Not useful if multiple valve disease
Pulse Doppler pulmonary venous flow Embedded Image Easy on TOE
Useful in eccentric or multiple jets
Systolic blunting occurs if high LA or LV end-diastolic pressure
Other causes for high E Vmax
Systolic flow dominantSystolic flow reversal
AR only
Pulse Doppler descending aortic flow Embedded Image Easy
If present in abdominal aorta, specific for severe AR
Less reliable when aortic stiffness increased (age)
Depends on alignment of Doppler with jet direction
Variable according to location of sample
Brief flow reversal is normalHolodiastolic, end-diastolic flow Vmax>20 cm/s
CW Doppler pressure half-time Embedded Image Easy
If long, specific for mild
Affected by any factor altering aortic-LV pressure gradient
Depends on alignment of Doppler with jet direction
>500 ms<200 ms
  • a/c, according to; AR, aortic regurgitation; CF, colour flow; CMR, cardiovascular magnetic resonance; EROA, effective regurgitant orifice; LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; MR, mitral regurgitation; MV, mitral valve; PISA, proximal isovelocity surface area; RF, regurgitant fraction; RVol, regurgitant volume; TOE, transoesophageal echocardiography; US, ultrasound.