A simplified, practical approach to assessment of severity of mitral regurgitation by Doppler color flow imaging with proximal convergence: Validation with concomitant cardiac catheterization

Objective: To compare the proximal convergence method for quantification of mitral regurgitation with findings on concomitant left ventriculography. Material and Methods: In 41 patients (22 men and 19 women, 63 +/- 13 years of age), mitral regurgitation was evaluated concomitantly by Doppler color flow jet area, proximal convergence method, and left ventriculography, A simplified measurement of the proximal convergence, consisting of the aliasing radius and velocity of the proximal isosurface (r(2) x V), was used. Results: Angiographic grade correlated well with the proximal convergence method (r(2) x V) but had poor correlation with the Doppler color flow jet area method. All patients with a proximal convergence flow rate of less than 10 cm(3)/s had grade 1 or 2 mitral regurgitation, whereas patients with a proximal convergence flow rate of more than 20 cm(3)/s had grade 3 or 4 mitral regurgitation. The severity of mitral regurgitation was indeterminate in patients with proximal convergence flow rates from 10 to 20 cm(3)/s. Conclusion: Doppler color flow jet area correlates pearly with angiographic grade of mitral regurgitation. A simplified proximal convergence method is useful for separating grade 3 and 4 from grade 1 and 2 mitral regurgitation in most patients. A group of patients with indeterminate severity of mitral regurgitation remains, however, in whom further assessment is necessary.