Assessment of mitral regurgitation through Doppler echocardiography: Feasibility, pitfalls and diagnostic advantages

Background: Echodoppler quantification of mitral regurgitation (MR) is still controversial, in particular little is known about correlation between quantitative and semi-quantitative methods. Methods and Results: 95 patients (pts) aged 58 +/- 13 years, 56% male, with at least moderate organic MR were enrolled in the period between Oct 2006 and Nov 2014. The etiology of MR was flail of MV leaflet. Regurgitant volume (RV) and effective regurgitant orifice (ERO) quantified by PISA (RV 56 ± 17 mL, ERO 0.32 ± 0.09 cm2), Doppler (RV 58 ± 17 mL, ERO 0.34 ± 0.12 cm2) and Volumetric (RV 48 ± 17 mL, ERO 0.27 ± 0.1 cm2) methods, were similar, particularly by quantitative Doppler and PISA (R2 0.89, p < 0.001). By semiquantitative methods jet area 4C was 9.1 ± 4.4 cm2, jet area/left atrium (LA) area 41 ± 20%, vena contracta (VC) was 5 ± 4.2 mm; pulmonary vein (PV) systolic flow reversal was present in 44% of patients. Only VC width among semiquantitative methods showed a sufficient correlation with RV (R2 0.52, p < 0.001), weaker with ERO (R2 0.46, p < 0.001). Conclusion: MR should be always evaluated by quantitative methods, particularly doppler and PISA RV and ERO, which showed the best correlation. Among semiquantitative methods only VC width represents a good option to RV or ERO evaluation by quantitative methods.