Assessment of colour flow imaging in the grading of valvular regurgitation
A R Galassi1, P Nihoyannopoulos, G Pupita
1Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K.
Insights
Colour flow imaging accurately grades valvular regurgitation, especially with normalized measurements. However, mild regurgitation can be overestimated, and etiology impacts accuracy in mitral and aortic valve disease.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Valvular regurgitation is a significant cardiac condition.
- Accurate grading of valvular regurgitation is crucial for patient management.
- Colour flow imaging is a widely used echocardiographic technique.
Purpose of the Study:
- To evaluate the diagnostic accuracy of colour flow imaging (CFI) in grading mitral and aortic regurgitation.
- To compare CFI findings with angiographic results.
- To assess the influence of disease etiology on CFI accuracy.
Main Methods:
- 100 patients with mitral/aortic regurgitation and 28 controls were studied.
- Mitral regurgitation assessed by jet area and normalized jet area.
- Aortic regurgitation assessed by jet area and normalized jet width.
Main Results:
- Normalized CFI measurements showed high correlation with angiography (mitral r=0.82, aortic r=0.94).
- CFI detected mild regurgitation in patients without angiographic evidence.
- Significant overlap in CFI measurements between mild and moderate regurgitation, particularly in rheumatic disease.
Conclusions:
- Normalized colour flow imaging is accurate for grading valvular regurgitation.
- Etiology (rheumatic vs. non-rheumatic) significantly impacts CFI accuracy, especially for aortic regurgitation.
- Awareness of potential overestimation of mild regurgitation and the role of etiology is important for interpretation.
Abstract:
To assess the accuracy of colour flow imaging in the grading of valvular regurgitation, we studied 100 consecutive patients with angiographic mitral regurgitation (55), aortic regurgitation (35) or both (10). The etiology of valve regurgitation was rheumatic in 42 and non-rheumatic in 58 patients. For comparison, 28 subjects with no structural cardiac disease were studied. Mitral valve regurgitation was assessed with colour flow imaging by measuring the maximal regurgitant jet area and the maximal jet area normalized to left atrial area; aortic valve regurgitation was assessed from jet area and jet width normalized to ventricular outflow tract width. The best correlation between colour flow imaging and angiography was obtained with normalized measurements for both mitral (r = 0.82, P less than 0.0001) and aortic regurgitation (r = 0.94, P less than 0.0001). A proportion of patients and controls without angiographic regurgitation showed evidence of mild mitral (31% and 32%) and aortic (14% and 11%) regurgitation on colour flow imaging. There was a large overlap in the normalized colour flow measurements between angiographically mild and moderate mitral regurgitation (43%); the overlap was greater when regurgitation was rheumatic in origin (45%) rather than non-rheumatic (10%) (P less than 0.001). There was also overlap in the normalized colour flow findings in patients with angiographic aortic regurgitation, which was greater in rheumatic vs non-rheumatic disease. Knowledge of the etiology significantly improved the separation of all angiographic grades of aortic regurgitation using colour flow measurements (P = 0.006).(ABSTRACT TRUNCATED AT 250 WORDS)
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