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CLINICAL STUDIES

Quantification of mitral regurgitation by automated cardiac output measurement: experimental and clinical validation

^a Cardiovascular Imaging Center, Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received November 3, 1997; revised manuscript received May 14, 1998, accepted June 1, 1998.

Address for correspondence: Dr. James D. Thomas, Department of Cardiology, Desk F 15, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
thomasj{at}cesmtp.ccf.org

Objectives. To develop and validate an automated noninvasive method to quantify mitral regurgitation.

Background. Automated cardiac output measurement (ACM), which integrates digital color Doppler velocities in space and in time, has been validated for the left ventricular (LV) outflow tract but has not been tested for the LV inflow tract or to assess mitral regurgitation (MR).

Methods. First, to validate ACM against a gold standard (ultrasonic flow meter), 8 dogs were studied at 40 different stages of cardiac output (CO). Second, to compare ACM to the LV outflow (ACMa) and inflow (ACMm) tracts, 50 normal volunteers without MR or aortic regurgitation (44 ± 5 years, 31 male) were studied. Third, to compare ACM with the standard pulsed Doppler-two-dimensional echocardiographic (PD-2D) method for quantification of MR, 51 patients (61 ± 14 years, 30 male) with MR were studied.

Results. In the canine studies, CO by ACM (1.32 ± 0.3 liter/min, y) and flow meter (1.35 ± 0.3 liter/min, x) showed good correlation (r = 0.95, y = 0.89x + 0.11) and agreement (CO(y – x) = 0.03 ± 0.08 [mean ± SD] liter/min). In the normal subjects, CO measured by ACMm agreed with CO by ACMa (r = 0.90, p < 0.0001, CO = –0.09 ± 0.42 liter/min), PD (r = 0.87, p < 0.0001, CO = 0.12 ± 0.49 liter/min) and 2D (r = 0.84, p < 0.0001, CO = –0.16 ± 0.48 liter/min). In the patients, mitral regurgitant volume (MRV) by ACMm-ACMa agreed with PD-2D (r = 0.88, y = 0.88x + 6.6, p < 0.0001, MRV = 2.68 ± 9.7 ml).

Conclusions. We determined that ACM is a feasible new method for quantifying LV outflow and inflow volume to measure MRV and that ACM automatically performs calculations that are equivalent to more time-consuming Doppler and 2D measurements. Additionally, ACM should improve MR quantification in routine clinical practice.

Abbreviations and Acronyms   ACM = automated stroke volume or cardiac output measurement   ACMa = automated stroke volume or cardiac output measurement through the left ventricular outflow tract   ACMm = automated stroke volume or cardiac output measurement through the mitral annulus   CO = cardiac output   MR = mitral regurgitation   MRV = mitral regurgitation volume   PD = pulsed Doppler measurement of stroke volume or cardiac output through the aortic annulus   SV = stroke volume   2D = left ventricular stroke volume or cardiac output calculated by two-dimensional echocardiography

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