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CLINICAL STUDIES

Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation

^a Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA
^* Section of Biostatistics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, USA

Manuscript received February 27, 1998; revised manuscript received June 2, 1998, accepted June 12, 1998.

Address for correspondence: Dr. Maurice Enriquez-Sarano, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905

Objectives. We sought to determine the reliability of the proximal isovelocity surface area (PISA) method for calculation of effective regurgitant orifice (ERO) of aortic regurgitation (AR).

Background. The ERO area can be calculated by the PISA method, but this method has not been validated in AR.

Methods. ERO calculation by the PISA method was undertaken prospectively in 71 consecutive patients with isolated AR and achieved in 64 and compared with two simultaneous reference methods (quantitative Doppler and quantitative two-dimensional echocardiography). In addition, this method was compared with angiography in 12 patients, with surgical assessment in 18 patients and with ventricular volumes in all patients.

Results. Good correlations between PISA and reference methods were obtained (both r = 0.90, both p < 0.0001), but a trend toward underestimation of the ERO by the PISA method was noted (24 ± 19 vs. 26 ± 22 mm² and 27 ± 23 mm², respectively, both p = 0.04). However, this trend was confined to five patients with an obtuse flow convergence angle (>220°), and on multivariate analysis this variable was the only independent determinant of underestimation of the ERO. In contrast, in 59 patients with a flat flow convergence (220°), the PISA method, in comparison with reference methods, showed excellent correlations, with a narrow standard error of the estimate (r = 0.95, SEE 5.4 mm², and r = 0.95, SEE 5.8 mm²; all p < 0.0001) and no trend toward underestimation (22 ± 18 vs. 23 ± 16 mm², p = 0.44, and vs. 23 ± 18 mm², p = 0.34).

Conclusions. In patients with AR, the PISA method can be used to measure the ERO with reasonable feasibility. Underestimation of the ERO by PISA may occur in patients with an obtuse flow convergence angle. However, in most patients with appropriate flow convergence, PISA provides reliable measurement of the ERO of AR.

Abbreviations and Acronyms   AR = aortic regurgitation   ERO = effective regurgitant orifice   FC = flow convergence   PISA = proximal isovelocity surface area   SEE = standard error of the estimate

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