Table 3
Multiparametric assessment of regurgitation
| Parameter | Advantages | Limitations | Mild | Severe | |
| 2D colour Doppler jet area |
| Easy screening for mild or severe If narrow, specific for mild | Subjective Overestimates if transient Underestimates if
Variable a/c to
| Narrow origin, small | Wide origin, large MR >50% MR/LA area AR>65% jet width/LVOT |
| 2D colour Doppler vena contracta width |
| 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 mm | MR >7 mm AR >6 mm |
| 2D colour Doppler flow convergence |
| Easy If absent, specific for mild | Multiple jets
Underestimates if
| If no flow convergence can be seen | >10 mm if Nyquist 30–40 cm/s |
| 3D colour Doppler vena contracta area |
| Useful if: Multiple jets If PISA non-hemispheric | Limits of temporal and spatial resolution 3D CF Overestimates if transient Slow | >40mm2 | |
| CW Doppler density |
| Easy Dense triangular shape specific for severe MR | Subjective Gain dependent Underestimates eccentric | Feint | Dense |
| 2D colour Doppler PISA |
| Quantitative: EROA mm2 RVol mls RF % Prognostic | Overestimates if Eccentric Transient Less accurate in functional MR | MR EROA<20 mm AR EROA<10 mm RVol<30 mL RF<30% | Primary MR>40 mm SIMR>20 mm AR EROA>30 mm RVol>60 mL RF>50% |
| Pulse Doppler |
| Quantitative: RVol mL RF % Can be used in Eccentric Transient Multiple jets | Wide confidence limits Difficult 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 |
| 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 |
| Easy Quantitative | AF 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 |
| Easy | AF Not useful if multiple valve disease | <1 | >1.4 |
| Pulse Doppler pulmonary venous flow |
| 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 dominant | Systolic flow reversal |
| AR only | |||||
| Pulse Doppler descending aortic flow |
| 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 normal | Holodiastolic, end-diastolic flow Vmax>20 cm/s |
| CW Doppler pressure half-time |
| 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.