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Clinical usefulness of the proximal isovelocity surface area method using echocardiography in patients with eccentric
1Second Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka, Japan.
Background And Aim Of The Study:
The Doppler color flow mapping techniques of the distal jet are influenced by the eccentricity of aortic regurgitation (AR). The aim of this study was to clarify screening variables for assessing AR severity in patients with an eccentric jet.
Methods:
Fifty-four patients with eccentric AR were studied. Values of the radius and effective regurgitant orifice area (EROA) determined by the proximal isovelocity surface area (PISA) method using transthoracic echocardiography (TTE) were compared with measurements by multiplane transesophageal echocardiography (m-TEE), aortic angiography and regurgitant fraction.
Results:
In patients with eccentric AR, values of PISA radius and EROA by TTE correlated well with values made by m-TEE (r = 0.87, p<0.001 and r = 0.86, p<0.001, respectively), angiographic grade (rs = 0.87, p<0.001 and rs = 0.88, p<0.001, respectively) and regurgitant fraction (r = 0.88, p<0.001 and r = 0.84, p<0.001, respectively). Values of PISA radius > or =0.70 cm and EROA > or =0.25 cm2 were always associated with a regurgitant fraction > or =0.40, while PISA radius <0.70 cm and EROA <0.25 cm2 were always associated with a regurgitant fraction <0.40.
Conclusions:
Measurements determined by the PISA method, using either TTE or m-TEE, are reliable for assessing the severity of eccentric AR. PISA radius is easy to obtain and therefore widely applicable in clinical practice as a screening tool for evaluating eccentric AR severity.