A Doppler-two-dimensional echocardiographic method for quantitation of mitral regurgitation

K. J. Ascah, W. J. Stewart, L. Jiang, J. L. Guerrero, J. B. Newell, Linda Gillam, A. E. Weyman

Research output: Contribution to journalArticle

58 Citations (Scopus)

Abstract

A noninvasive method to accurately quantitiate the severity of mitral insufficiency would be of major clinical value. In theory, in the absence of confounding variables, regurgitant mitral flow should represent the difference between forward mitral blood flow and aortic blood flow. Since Doppler-two-dimensional echocardiographic (D2DE) methods for measuring transvalvular mitral and aortic flow have been validated, it should be possible to use mitral and aortic flows derived by this method to calculate regurgitant mitral flow. To assess the validity and accuracy of this combined approach for quantitation of regurgitant flow, we developed an open-chest canine preparation in which we could simulate, vary, and accurately measure degrees of mitral regurgitation. Seven animals were anesthetized and prepared to allow controlled right heart output. Mitral regurgitation was then simulated by placing a flexible conduit incorporating a one-way valve and electromagnetic flowmeter between the left ventricular apex and left atrium. Flow through the tube (effective mitral regurgitation) was varied between 0.2 and 1.8 liters/min and forward cardiac output ranged between 0.5 and 4 liters/min. Transmitral and transaortic flows were calculated by previously reported Doppler methods. Doppler-derived estimates of forward flow through the aortic valve correlated well with the flow measured by flowmeter (r = .92), and regurgitant flow and regurgitant fraction calculated by the D2DE approach also compared well with those measured by flowmeter (r = .84 and .83, respectively). This study demonstrates that mitral regurgitant flow and regurgitant fraction calculated by the D2DE method provide an acceptable measure of both absolute regurgitant flow and the regurgitant fraction in the experimental setting.

Original languageEnglish (US)
Pages (from-to)377-383
Number of pages7
JournalCirculation
Volume72
Issue number2
DOIs
StatePublished - Jan 1 1985

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Mitral Valve Insufficiency
Flowmeters
Confounding Factors (Epidemiology)
Electromagnetic Phenomena
Heart Atria
Aortic Valve
Cardiac Output
Canidae
Thorax

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ascah, K. J., Stewart, W. J., Jiang, L., Guerrero, J. L., Newell, J. B., Gillam, L., & Weyman, A. E. (1985). A Doppler-two-dimensional echocardiographic method for quantitation of mitral regurgitation. Circulation, 72(2), 377-383. https://doi.org/10.1161/01.CIR.72.2.377
Ascah, K. J. ; Stewart, W. J. ; Jiang, L. ; Guerrero, J. L. ; Newell, J. B. ; Gillam, Linda ; Weyman, A. E. / A Doppler-two-dimensional echocardiographic method for quantitation of mitral regurgitation. In: Circulation. 1985 ; Vol. 72, No. 2. pp. 377-383.
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Ascah, KJ, Stewart, WJ, Jiang, L, Guerrero, JL, Newell, JB, Gillam, L & Weyman, AE 1985, 'A Doppler-two-dimensional echocardiographic method for quantitation of mitral regurgitation', Circulation, vol. 72, no. 2, pp. 377-383. https://doi.org/10.1161/01.CIR.72.2.377

A Doppler-two-dimensional echocardiographic method for quantitation of mitral regurgitation. / Ascah, K. J.; Stewart, W. J.; Jiang, L.; Guerrero, J. L.; Newell, J. B.; Gillam, Linda; Weyman, A. E.

In: Circulation, Vol. 72, No. 2, 01.01.1985, p. 377-383.

Research output: Contribution to journalArticle

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N2 - A noninvasive method to accurately quantitiate the severity of mitral insufficiency would be of major clinical value. In theory, in the absence of confounding variables, regurgitant mitral flow should represent the difference between forward mitral blood flow and aortic blood flow. Since Doppler-two-dimensional echocardiographic (D2DE) methods for measuring transvalvular mitral and aortic flow have been validated, it should be possible to use mitral and aortic flows derived by this method to calculate regurgitant mitral flow. To assess the validity and accuracy of this combined approach for quantitation of regurgitant flow, we developed an open-chest canine preparation in which we could simulate, vary, and accurately measure degrees of mitral regurgitation. Seven animals were anesthetized and prepared to allow controlled right heart output. Mitral regurgitation was then simulated by placing a flexible conduit incorporating a one-way valve and electromagnetic flowmeter between the left ventricular apex and left atrium. Flow through the tube (effective mitral regurgitation) was varied between 0.2 and 1.8 liters/min and forward cardiac output ranged between 0.5 and 4 liters/min. Transmitral and transaortic flows were calculated by previously reported Doppler methods. Doppler-derived estimates of forward flow through the aortic valve correlated well with the flow measured by flowmeter (r = .92), and regurgitant flow and regurgitant fraction calculated by the D2DE approach also compared well with those measured by flowmeter (r = .84 and .83, respectively). This study demonstrates that mitral regurgitant flow and regurgitant fraction calculated by the D2DE method provide an acceptable measure of both absolute regurgitant flow and the regurgitant fraction in the experimental setting.

AB - A noninvasive method to accurately quantitiate the severity of mitral insufficiency would be of major clinical value. In theory, in the absence of confounding variables, regurgitant mitral flow should represent the difference between forward mitral blood flow and aortic blood flow. Since Doppler-two-dimensional echocardiographic (D2DE) methods for measuring transvalvular mitral and aortic flow have been validated, it should be possible to use mitral and aortic flows derived by this method to calculate regurgitant mitral flow. To assess the validity and accuracy of this combined approach for quantitation of regurgitant flow, we developed an open-chest canine preparation in which we could simulate, vary, and accurately measure degrees of mitral regurgitation. Seven animals were anesthetized and prepared to allow controlled right heart output. Mitral regurgitation was then simulated by placing a flexible conduit incorporating a one-way valve and electromagnetic flowmeter between the left ventricular apex and left atrium. Flow through the tube (effective mitral regurgitation) was varied between 0.2 and 1.8 liters/min and forward cardiac output ranged between 0.5 and 4 liters/min. Transmitral and transaortic flows were calculated by previously reported Doppler methods. Doppler-derived estimates of forward flow through the aortic valve correlated well with the flow measured by flowmeter (r = .92), and regurgitant flow and regurgitant fraction calculated by the D2DE approach also compared well with those measured by flowmeter (r = .84 and .83, respectively). This study demonstrates that mitral regurgitant flow and regurgitant fraction calculated by the D2DE method provide an acceptable measure of both absolute regurgitant flow and the regurgitant fraction in the experimental setting.

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