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

被引:224
作者
Hall, SA
Brickner, ME
Willett, DL
Irani, WN
Afridi, I
Grayburn, PA
机构
[1] UNIV TEXAS, SW MED CTR, DIV CARDIOL, DEPT MED, DALLAS, TX 75235 USA
[2] VET ADM MED CTR, DALLAS, TX 75216 USA
关键词
echocardiography; regurgitation; mapping;
D O I
10.1161/01.CIR.95.3.636
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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-wave 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 greater than or equal to 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 less than or equal to 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.
引用
收藏
页码:636 / 642
页数:7
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