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CLINICAL STUDY: VALVE DISEASE

Specificity of Doppler echocardiography for the assessment of changes in valvular regurgitation: comparison of side-by-side versus serial interpretation

Neil J. Weissman, MD, FACC^*, Julio A. Panza, MD, FACC, John F. Tighe, Jr., MD, FACC, Susan T. Perras, RN, MSN, Harvey Kushner, PhD and John S. Gottdiener, MD, FACC^||

^* Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA
Cardiology Branch, National Heart, Lung and Blood Institute, Bethesda, Maryland, USA
Cardiovascular Research Institute, New Windsor, New York, USA
Department of Clinical Research, Wyeth-Ayerst Research, Philadelphia, Pennsylvania, USA
^|| St. Francis Hospital, Division of Cardiology, Roslyn, New York, USA

Manuscript received August 31, 2000; revised manuscript received January 22, 2001, accepted February 1, 2001.

Reprint requests and correspondence: Dr. Neil J. Weissman, Cardiovascular Research Institute, Suite 4B-1, Washington Hospital Center, 110 Irving Street, NW, Washington, DC 20010
njw1{at}mhg.edu

OBJECTIVES

We sought to determine the specificity of two different methods for assessing change in aortic (AR), mitral (MR) and tricuspid (TR) valvular regurgitation.

BACKGROUND

Echocardiographic imaging with Doppler is the standard noninvasive diagnostic tool for assessing valvular structure and function. Change can be assessed using either independent evaluations (serial) or using a side-by-side comparison.

METHODS

Subjects were from the placebo arm of a randomized, double-blind, clinical trial. Three echocardiograms over 10 months were performed. An initial and three-month echocardiogram were read as independent groups, blinded to all parameters except sequence. The initial and 10-month echocardiograms were read side-by-side, blinded to all parameters including sequence.

RESULTS

Two hundred nineteen predominantly healthy, obese, white, middle-aged women had initial and three-month echocardiograms (acquisition interval 105 ± 28 days) evaluated by the serial method (mean 167 ± 61 days between interpretations). The same subjects had the initial and 10-month studies (acquisition interval 303 ± 27 days) compared side-by-side. The specificity of the serial versus side-by-side method for determining change in MR grade was 55.8% versus 93.2% (p < 0.001); TR: 63.8% versus 97.6% (p < 0.001) and AR: 93.7% versus 97.6 (p = 0.08). Notably, most of the change occurred in a range (none versus physiologic/mild) that has limited clinical significance. Furthermore, the percentage of echocardiograms interpreted as nonevaluable was lower with the side-by-side method for MR (5.0% vs. 16.0%, p = 0.06), TR (4.6% vs. 15.5%, p < 0.001) and AR (4.1% vs. 12.3%, p = 0.002).

CONCLUSIONS

The side-by-side method of assessing change in valvular regurgitation appears to be the more reliable method with a higher specificity and minimal data loss.

Abbreviations and Acronyms   AR = aortic regurgitation   MR = mitral regurgitation   TR = tricuspid regurgitation

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