Early Assessment of Left Ventricular Function by Layer-Specific Strain and Its Relationship to Pulsatile Arterial Load in Patients with Coronary Slow Flow.

Previous studies reported a controversial left ventricular (LV) function impairment and pathophysiology in patients with coronary slow flow (CSF). Greater arterial load has been shown to increase aortic impedance and endothelial shear stress, potentially affecting coronary anatomy and function. We investigated LV systolic function by a new layer-specific strain technology and assessed the association between pulsatile arterial load and contractility.A total of 70 patients with CSF and 50 controls with normal coronary angiography were included in the study. Layer-specific longitudinal and circumferential strains were assessed from endocardium, mid-myocardium, and epicardium (global longitudinal strain (GLS)-endo, GLS-mid, GLS-epi and GCS-endo, GCS-mid, GCS-epi) by two-dimensional speckle tracking imaging (2D-STI). Pulsatile arterial load was estimated by indexed arterial compliance (ACI). Layer-specific GLS showed a decreasing gradient from the endocardium to the epicardium in both the controls and CSF group. GLS-endo and GLS-mid in the CSF group were significantly lower than the control group (all P < 0.05). Layer-specific longitudinal strain showed a good correlation with the number of affected coronary arteries (all P < 0.05) and the mean thrombolysis in the myocardial infarction frame count (TFC) (all P < 0.05). ACI was lower in patients with CSF (P = 0.005), and ACI was correlated negatively with layer-specific GLS (all P < 0.05).Layer-specific evaluation of the LV provides an understanding of the layer-specific properties of the LV wall and the possible process of the LV impairment in patients with CSF. Greater pulsatile arterial load, as manifested by a lower ACI, is coupled with worse LV longitudinal function in patients with CSF.

Assessment of aortopulmonary collateral flow and pulmonary vascular growth using a 3.0 T magnetic resonance imaging system in patients who underwent bidirectional Glenn shunting.

OBJECTIVES: To explore the feasibility of evaluating the aortopulmonary collateral flow (APCF) and pulmonary vascular growth of patients who underwent bidirectional Glenn shunting (BGS) using phase-contrast magnetic resonance imaging (PC-MRI) and contrast-enhanced magnetic resonance imaging (CE-MRI). METHODS: Blood flow measurements of the great vessels of the body were recorded in 22 post-BGS patients using 3.0 T PC-MRI. Right and left pulmonary blood flow (Q(P)), stroke volume (SV) of the ascending aorta (Q(S)), blood flow of descending aorta (Q(d)) and venous return of the superior and inferior venae cavae (Q(V)) per minute were calculated using the Report Card software. APCF was equal to the difference between Q(S) and Q(V). The parameters for pulmonary vascular growth were assessed using CE-MRI. The relationship between pulmonary vascular growth and APCF was evaluated using correlation analysis. A comparative analysis was conducted between the MRI results and the results of five cases who underwent cardiac catheterization and 10 cases who underwent angiography. RESULTS: Estimated APCF ranged from 0.23 to 1.63 l/(min/m(2)), accounting for 5-44% of Q(S). Morphologic abnormalities such as pulmonary stenosis, dilatation and thrombosis were clearly visualized through CE-MRI. Significant differences in individual pulmonary artery growth were observed. A significant negative correlation was found between APCF and the pulmonary artery index (PAI; r = -0.461, P = 0.031) when the McGoon rate was 2.04 ± 0.59 and the PAI was 253.27 ± 85.86 mm(2)/m(2). Good consistency or relativity was found between cardiac catheterization, angiography and MRI. CONCLUSIONS: Assessing the APCF and parameters for pulmonary vascular growth in patients who underwent BGS is feasible using 3.0 T PC-MRI integrated with CE-MRI, which may play an important role in clinical and therapeutic decision-making and prognostic evaluation.

Radionuclide and angiographic assessment of pulmonary perfusion after Fontan procedure: comparative interim outcomes.

BACKGROUND: Right-side heart function is essentially externalized during extracardiac total cavopulmonary connection. The Fontan procedure has a certain impact on pulmonary hemoperfusion and may explain various postsurgical complications. In this study, alterations of pulmonary perfusion in patients undergoing the Fontan procedure were analyzed at the 5-year postoperative mark by radionuclide imaging and angiocardiography, and results of both methods were compared. METHODS: For 43 post-Fontan patients, perfusion ratios of each lung segment were calculated based on radionuclide imaging data. The pulmonary vascular resistance and pulmonary artery index of each patient were also calculated from right angiocardiographic measurements. RESULTS: The radionuclide count and advantage perfusion ratio of right lung at follow-up did not differ significantly from early postoperative values (t=0.38, p>0.05; t=1.12, p>0.05), and superior/inferior vena cava perfusion ratios were stable (t=0.88, p>0.05; t=0.74, p>0.05). The superior/inferior segment perfusion ratio of the whole lung declined significantly (t=2.54, p<0.05), while that of the dorsal lung segment rose significantly (t=2.16, p<0.05). Compared with early postoperative status, the pulmonary arterial index of patients at follow-up were significantly increased (t=2.41, p<0.05), while small pulmonary vascular resistances declined significantly (t=2.08, p<0.05; t=2.69, p<0.05), and arterial oxygen saturation levels were unaltered (t=1.12, p>0.05). The early angiographic and radionuclide perfusion studies of 5 patients did not match. CONCLUSIONS: After the Fontan procedure, hypostatic redistribution of pulmonary blood flow is characteristic. The weak pulse of blood, in the absence of ventricular ejection, can promote pulmonary vascular changes, but at later (intermediate) follow-up, the decline in vascular resistance that results carries no benefit in terms of blood perfusion or oxygenation. Microcirculatory arteriovenous shunting is the likely cause. In this study of functional pulmonary hemoperfusion, radionuclide imaging was deemed superior to angiocardiography.

[Evaluation of hospital admissions for angiocardiographic procedures in patients with cardiovascular disease (DRG 124): a retrospective study in four Rome hospitals (Italy)]. / Analisi dei ricoveri ordinari finalizzati all'esecuzione di esami angiocardiografici per patologie cardiovascolari attributi al DRG 124: studio retrospettivo in quattro ospedali di Roma.

The aim of this study was to evaluate hospital admissions assigned to DRG 124 because attributable to the diagnosis and therapy of cardiovascular diseases and the performance of an angiocardiographic exam with contrast and/or cardiac catheterism. As part of the hospital activity evaluations performed by the Lazio Region between 1 January 2002 and 30 June 2005 in four healthcare institutions in the Rome metropolitan area, 136 admissions assigned to DRG 124 were evaluated. An evaluation grid was used to verify information recorded in the hospital discharge forms and hospital medical records for these admissions. Overall 89% (121/136) of medical records were found to be incongruent with the corresponding hospital discharge form and 53% of admissions (72/136) were reassigned a different DRG after evaluation. In most of these cases (n=54; 76%) the selection of a different DRG was required because an incorrect main diagnosis had originally been chosen. The mean relative weight of admissions in which DRG reassignment was required was 1.4189 before recoding and 0.7545 after these were assigned to a new DRG.

Assessment of regional left ventricular function by dual source computed tomography: interobserver variability and validation to laevocardiography.

OBJECTIVE: Assessment of left ventricular function is possible in contrast-enhanced cardiac CT data sets. However, rapid ventricular motion especially in systole can lead to artifacts. Dual Source Computed Tomography (DSCT) has high temporal resolution which effectively limits motion artifact. We therefore assessed the accuracy of DSCT to detect regional left ventricular wall motion abnormalities in comparison to invasive cine angiocardiography. METHODS: We analyzed DSCT data sets of 50 patients (39 male, 11 female, mean age: 61+/-10 years) which were acquired after intravenous injection of 55-70 mL contrast agent (rotation time: 330 ms, collimation: 2 mm x 64 mm x 0.6 mm, 120 kV, 380 mAs, ECG-correlated tube current modulation). 10 data sets consisting of transaxial slices with a slice thickness of 1.5 mm, an increment of 1.0 mm and a matrix of 256 x 256 pixels were reconstructed at 10 time instants during the cardiac cycle (0-90% in 10% increments). The data sets were analyzed visually by two independent readers, using standard left ventricular planes, concerning regional wall motion abnormalities. DSCT was verified in a blinded fashion against cine ventriculography performed during cardiac catheterization (RAO and LAO projection), using a 7-segment model. Analysis was performed on a per-patient (presence of at least one hypo-, a- or dyskinetic segment) and on a per-segment basis. RESULTS: Concerning the presence of a wall motion abnormality, the two observers agreed in 340/350 segments (97%) and 48/50 patients (96%). In invasive cine angiocardiography, 22 of 50 patients displayed at least one segment with abnormal contraction. To detect these patients, DSCT showed a sensitivity of 95% (21/22), specificity of 96% (27/28), positive predictive value of 95% and negative predictive value of 96%. Out of a total of 350 left ventricular segments, 66 segments had abnormal contraction in cine angiocardiography (34 hypokinetic, 26 akinetic, 6 dyskinetic). For detection of these segments, DSCT had a sensitivity of 88% (58/66), specificity of 98% (278/284), positive predictive value of 91% (58/64) and negative predictive value of 97% (278/286). CONCLUSION: DSCT allows the detection of regional wall motion abnormalities with high interobserver agreement as well as high sensitivity and specificity. Whereas sensitivity and positive predictive value were higher in a per-patient- in comparison to a per-segment-based analysis, specificity, negative predictive value and interobserver agreement did not differ considerably between both analyzing methods.

Survey on performance assessment of cardiac angiography systems.

Advances in imaging technology have facilitated the development of increasingly complex interventional cardiac equipment. Consequently, there is a need for definitive equipment requirements. The aim of the study is to assess the performances of different cardiac angiographic systems. A questionnaire was sent to centres participating in SENTINEL Project to collect dosimetry data (typical entrance dose rate in fluoroscopy and imaging mode), image quality evaluations (low and high contrast resolutions) and KAP calibration factors. Results from this survey could contribute to the explanation of patient dose variability in angiographic cardiac procedures and to derive reference levels for cardiac angiographic equipment performance parameters.

Assessment of global left ventricular function: comparison of cardiac multidetector-row computed tomography with angiocardiography.

OBJECTIVE: Evaluation of left ventricular function using electrocardiogram (ECG)-gated multidetector row CT (MDCT) by using 3 different volumetric assessment methods in comparison to assessment of the left ventricular function by invasive ventriculography. METHODS: Thirty patients with suspected or known coronary artery disease underwent MDCT coronary angiography with retrospective ECG cardiac gating. Raw data were reconstructed at the end-diastolic and end-systolic periods of the heart cycle. To calculate the volumes of the left ventricle, 3 methods were applied: The 3-dimensional data set (3D), the geometric hemisphere cylinder (HC), and the geometric biplane ellipsoid (BE) methods. End-diastolic volumes (EDV), end-systolic volumes (ESV), the stroke volumes (SV), and ejection fractions (EF) were calculated. The left ventricular volumetric data from the 3 methods were compared with measurements from left ventriculography (LVG). RESULTS: The best results were obtained using the 3D method; EDV (r = 0.73), ESV (r = 0.88), and EF (r = 0.76) correlated well with the LVG data. The EDV volumes did not differ significantly between LVG and the 3D method (P = 0.24); however, ESV, SV, and EF differed significantly. The ESV were significantly overestimated (P < 0.01), leading to an underestimation of the SV (P < 0.01) and the EF (P < 0.01). The HC method resulted in the greatest overestimation of the volumes. The EDV and the ESV were 31.8 +/- 37.6% and 136.4 +/- 92.9% higher than the EDV and ESV volumes obtained by LVG. Bland-Altman analysis showed systematic overestimation of the ESV using the HC method. CONCLUSION: MDCT with retrospective cardiac ECG gating allows the calculation of left ventricular volumes to estimate systolic function. The 3D method had the highest correlation with LVG. However, the overestimation of the ESV is significant, which led to an underestimation of the SV and the EF.

[Quantitative assessment of right ventricular contractility by contrast angiography in healthy persons and patients with ischemic heart disease]. / Kolichestvennaia otsenka sokratimosti pravogo zheludochka pri rentgenokontrastnoi angiografii u zdorovykh lits i bol'nykh ishemicheskoi bolezn'iu serdtsa.

Absence of special programs for quantitative analysis of right ventricular volumes and function precludes precise evaluation of right ventriculography data. We used standard programs designed for analysis of left ventriculograms for evaluation of right ventricular volumes and function in 32 patients without and 20 patients with coronary artery disease. Left ventriculography and right angiography were carried out in 30- and 60-degree right and left anterior oblique projections, respectively. Average correction factors obtained by comparison of left and right ventricular stroke volumes were 0.9243+/-0.2887 and 0.8758+/-0.2232 for patients without and with coronary artery disease, respectively. Such conversion was considered to be simple and adequate method of adaptation of existing programs of quantitative analysis of angiograms for evaluation of right ventricular volumes and function.

[MRI in postoperative assessment of univentricular heart disease: correlation with echocardiography and angiography]. / MRT in der postoperativen Diagnostik bei funktionell univentrikulärem Herz: Korrelation zu Echokardiographie und Kardangiographie.

PURPOSE: To determine the value of MRI in the postoperative evaluation of a singular ventricle compared to echocardiography and cardiac catheterization. MATERIALS AND METHODS: Thirty-one patients (range: 6 months to 30 years) with a functional single ventricle following palliative corrective operations. Five patients had a Blalock-Taussig-Shunt, 8 patients a Glenn-Anastomosis and 18 a cavopulmonary shunt (6 with classic Fontan-Circulation, 12 with modified cavopulmonary anastomosis). The results in terms of postoperative morphologic changes were compared to percutaneous echocardiography (31/31) and cardiac catheterization (6/31). RESULTS: Echocardiography, which was performed on all patients, could not visualize the entire length of the tunnel, the Glenn-Anastomosis or the central pulmonary arteries in 70 % of the patients due to an inadequate acoustic window. MRI was able to show the entire tunnel in 11/12 patients and the central pulmonary arteries in 30/31 patients. The exact anatomy was seen in all 6 patients undergoing cardiac catheterization. CONCLUSION: MRI is useful in the postoperative evaluation of a functionally single ventricle. It is superior to echocardiography. Cardiac catheterization should be reserved for patients with inconclusive MRI findings.

[Multiplane transesophageal echocardiography in the preoperative evaluation of the sinus of Valsalva fistula to right chambers]. / Ecocardiografía transesofágica multiplana en la valoración preoperatoria de fístulas de senos de Valsalva en cavidades derechas.

INTRODUCTION AND OBJECTIVES: Ruptured sinus of Valsalva aneurysm to right cardiac chambers is an uncommon lesion in Western countries. The prognosis is usually serious unless the condition is promptly treated surgically. For this reason an accurate anatomical and functional evaluation is necessary. The main purpose of this report is to compare the usefulness of multiplane transesophageal echocardiography with transthoracic echocardiography and angiocardiography in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers. PATIENTS AND METHOD: Since January 1990, 9 patients (mean age 36,3 18 yr, 6 males) with ruptured sinus of Valsalva aneurysm to right chambers were studied. The pathogenesis was congenital aneurysm in 6 patients, aortic prosthesis endocarditis in one and two cases of iatrogenia: during a percutaneous mitral valvuloplasty and after cardiac surgery. Transthoracic echocardiography was performed in all cases, transesophageal echocardiography in 7 and angiocardiography in 8. Two patients died before surgery, and 7 were successfully operated on. RESULTS: Transesophageal echocardiography was more useful when compared to transthoracic echocardiography and angiocardiography in detecting: a) the fistula; b) the sinus involved; c) the right chamber affected; d) congenital aneurysms morphology and size; e) aneurysm prolapse through a ventricular septal defect, y f) the identification of other cardiac congenital or acquired anomalies. CONCLUSIONS: Multiplane TEE is the most accurate tool in the preoperative evaluation of ruptured sinus of Valsalva aneurysm to right chambers.

Intracardiac ultrasound assessment of atrial septal defect: comparison with transthoracic echocardiographic, angiocardiographic, and balloon-sizing measurements.

PURPOSE: Accurate evaluation of the size, location and adjacent structure of an atrial septal defect (ASD) is very important in the selection of patients for further management. We directly compared the utility of transthoracic echocardiography, angiocardiography, balloon sizing, and intracardiac ultrasound (ICUS) in the detection of ASD. METHODS: Twenty-one children underwent an ICUS study of ASD after routine clinical and laboratory studies. All patients had received transthoracic echocardiography (TTE), cardiac catheterization, cineangiography, and balloon sizing before the ICUS to evaluate the ASD. RESULTS: There was a significant correlation between the ICUS-derived ASD diameter and the other methods (p < 0.001). The balloon-sizing diameter was estimated by the equation: TTE diameter x 1.09 + 3.9 mm. There was a good correlation between the predicted and measured balloon-sizing diameter (r = 0.963; p < 0.001). CONCLUSION: It is worthwhile spending a few minutes to perform ICUS during cardiac catheterization since it will provide more detailed information on and high resolution images of atrial septal morphology, especially for patients undergoing transcatheter closure by device.

Global left ventricular cardiac function: comparison between magnetic resonance imaging, radionuclide angiography, and contrast angiography.

RATIONALE AND OBJECTIVES: Cardiac magnetic resonance imaging (MRI) has been shown to be a robust and noninvasive method to assess left ventricular (LV) cardiac function. This study sought to assess volumes and mass calculated with MRI using fast techniques for acquisition and postprocessing, and to compare results in terms of cost-effectiveness with those of radionuclide angiography (RNA) or contrast angiography (CA). METHODS: Thirty-five patients and 15 healthy volunteers were studied. All patients underwent an MRI examination during the same period that they underwent ventriculography (26 patients) or radiography (25 patients). From 7 to 11 short-axis slices were acquired with a breath-hold fast-gradient echo-segmented sequence from apex to base. Contours were drawn with an automated border detection software. RESULTS: Ejection fraction (EF) correlated well between modalities (r = 0.77, P<0.001, for MRI and RNA; r = 0.72, P< 0.001, for MRI and CA). CONCLUSIONS: Cardiac MRI is a fast and accurate technique for estimation of LV volumes, EF, and mass.

Quantitative assessment of surgically induced mitral regurgitation using radionuclide ventriculography and first pass radionuclide angiography.

Radionuclide ventriculography has been used in humans to evaluate valvular incompetency. The stroke volume ratio, derived from the radionuclide ventriculogram, is used to quantify the severity of mitral regurgitation (MR). Previous studies conducted in humans have shown that left to right stroke volume ratio increases as the severity of MR increases. In this study, we evaluated radionuclide ventriculography as a noninvasive method to detect MR in dogs with surgically created mitral insufficiency. Six male and three female adult, conditioned mongrel dogs were used. Scintigraphic studies were performed prior to and 4 weeks after surgically created MR. Because of the overlap of the left and right ventricles when viewed from a left lateral position, we combined data from a first-pass radionuclide angiocardiogram with the radionuclide ventriculogram to obtain a corrected stroke volume ratio. Blood flow transit parameters were also derived from the first-pass radionuclide angiocardiogram. Standard left ventricular functional indices were also measured from the radionuclide ventriculogram. On the left lateral view of the heart, 25 to 30% of the right ventricular volume overlaps the left ventricle. After correcting for the overlap, the stroke volume ratio of normal dogs was 1.17+/-0.178 (mean+/-SD), which increased to 2.06+/-0.41 (mean+/-SD) (p < .001) 4 weeks after creation of MR. The was no significant change in left ventricular ejection fraction or peak rate of ejection following MR. The transit times of blood through the left ventricle were measured from the first-pass radionuclide angiocardiogram and were expressed as half-time clearance, peak clearance rate, and time to peak clearance rate. The baseline half-time clearance was 2.07+/-0.71 s (mean+/-SD), which increased to 6.70+/-4.89 s (mean+/-SD) (p = .02) after creation of MR. The baseline peak clearance rate was 49.75+/-8.96 cts/s (mean+/-SD), which decreased to 23.12+/-6.84 cts/s (mean+/-SD) (p < .001) after creation of MR. Stroke volume ratios significantly increased following creation of MR. Blood flow transit through the left ventricle slowed following creation of MR. The variability of these parameters were small in the baseline studies, suggesting these techniques may be clinically useful to gauge the severity of MR in dogs.

Determination of ventricular ejection fraction: a comparison of available imaging methods. The Cardiovascular Imaging Working Group.

Knowledge of left ventricular ejection fraction has been shown to provide diagnostic and prognostic information in patients with known or suspected heart disease. In clinical practice, the ejection fraction can be determined by using one of the five currently available imaging techniques: contrast angiography, echocardiography, radionuclide techniques of blood pool and first pass imaging, electron beam computed tomography, and magnetic resonance imaging. In this review, we discuss the clinical application as well as the advantages and disadvantages of each of these methods as it relates to determination of ventricular ejection fraction.

[Long-term recovery of regional wall motion in patients with medically treated anterior myocardial infarction: quantitative assessment of the post-infarction left ventriculograms].

The effect of medical treatment without reperfusion therapy on the long-term recovery of regional wall motion was evaluated retrospectively in 28 patients with transmural acute anterior myocardial infarction who had coronary angiography and left ventriculography at 1-6 months after the onset of the episode and were followed for a mean of 65 months. In all patients, initial coronary angiography revealed significant stenosis in only the left anterior descending artery (LAD). All patients were treated medically without reperfusion therapy (such as thrombolytic therapy, angioplasty, or bypass grafting). The regional wall motion in the LAD territory was measured by the centerline method using the right anterior oblique projection. Long-term improvement in anterior wall motion is unlikely in patients with patent LAD or underdeveloped collaterals to the LAD (38%). However, subsequent anterior wall motion frequently improved among patients with severely stenotic or occluded LAD (63%) and well-developed collaterals (73%). Therefore, the anterior wall motion of some LAD-related infarctions improves spontaneously, the extent of coronary collaterals is an important determinant of long-term improvement, and the improvement in wall motion is completed within the early period of acute anterior infarction in patients with patent LAD.

[Circularity index of left ventricular shape in the assessment of heart disease].

Left ventricular volume and ejection fraction obtained by cineangiography are useful to evaluate global left ventricular function in humans. Left ventriculography provides evidence of the effect of coronary artery stenosis on regional wall motion in patients with coronary artery disease. Changes in left ventricular shape are also found in various heart diseases. The left ventricular cavity is normally ellipsoid in shape, but becomes flat in hypertrophic cardiomyopathy, globular in dilated cardiomyopathy, and aneurysmal in some patients with myocardial infarction. This study developed a new method to quantify regional and global left ventricular shape. Regional circularity index (RCI) was defined as GD divided by r (GD = distance from each 5-degree endocardial margin to the center of gravity, r = radius of the circle equal to left ventricular area). The global circularity index (GCI) was derived from the sum of magnitude of RCI-1. The end-systolic GCI was related to end-systolic left ventricular wall stress (r = 0.71, p < 0.001). The change in GCI during systole was related to left ventricular ejection fraction (r = 0.79, p < 0.001). In severe cases of dilated cardiomyopathy, the left ventricle became more spherical during ejection. End-systolic left ventricular moment around the minor axis had a good correlation with left ventricular ejection fraction (r = 0.81, p < 0.001). Quantification of regional and global left ventricular shape can be used to estimate left ventricular wall stress from left ventricular shape. Left ventricular shape change during systole and the moment around the left ventricular short axis contributes to left ventricular ejection.

[Value of thoracic radiography in the assessment of cardiac size. A comparison with left ventricular cardiography]. / Stellenwert der Thoraxübersichtsaufnahme in der Beurteilung der Herzgrösse. Ein Vergleich mit den Ergebnissen der Lärokardiographie.

PURPOSE: To determine the value of standard chest radiographs in the assessment of cardiac size. METHODS: In 193 patients cardiac size was compared between standard chest radiographs in the posteroanterior and lateral projection and left ventricular angiograms. The following parameters were determined: transverse diameter, lateral horizontal transverse diameter, cardiothoracic ratio and end-diastolic volume index (EDVI) and ejection fraction (EF). RESULTS: Subjective assessment of the left ventricular size resulted in a mean sensitivity/specificity/accuracy of 69.7%/87.4%/82.0% respectively, in comparison to EDVI. Estimation of global heart size yielded a mean sensitivity/specificity/accuracy of 48.8%/93.6%/77.8%, respectively, in comparison to EF. Cardiothoracic ratio for the detection of pathological EDVI or EF had a sensitivity of 77.3%/57.4% a specificity of 79.3%/80.8% and an accuracy of 78.9%/72.5%. CONCLUSIONS: Standard chest radiographs with the determination of cardiothoracic ratio remain a clinically relevant procedure for screening and follow-up of heart disease.

[Assessment of severity of mitral insufficiency--value of various color Doppler echocardiographic methods]. / Schweregradbestimmung bei Mitralinsuffizienz--Wertigkeit verschiedener farbdopplerechokardiographischer Methoden.

A total of 79 patients with mitral regurgitation (age 62 +/- 11 years, 45 men, 34 women) quantified by angiography was studied using color-Doppler imaging of isovelocity surface areas in the flow convergence region proximal to the regurgitant orifice (PISAs), of the jet cross-section at the level of the regurgitant orifice and of the regurgitant jet in the left atrium. The PISA-radii for the flow velocities (aliasing borders) of 28 and 41 cm/s, the cross-sectional jet area and the jet length, and relation of jet area to left atrial area were measured. The sensitivity for the detection of mitral regurgitation was at least 97% for the color-Doppler methods investigated in these patients in which a sufficient imaging was obtained. However, a sufficient imaging of the flow convergence region and the jet cross-section was not possible in about 5% of all patients. The PISA-radii for both flow velocities and the cross-sectional jet area correlated more closely with the angiographic grade (rSp = 0.79-0.80, p < 0.001) than the jet area (rSp = 0.39, p < 0.001), jet length (rSp = 0.37, p < 0.001), and relation of jet area to left atrial area (rSp = 0.31, p < 0.01) did. A correct differentiation of grades I to II from grades III to IV mitral regurgitation was provided in 93-95% of patients by the proximal flow convergence and by the cross-sectional jet area method and, at most, in 76% of the patients by the jet area method using the uncorrected jet area.(ABSTRACT TRUNCATED AT 250 WORDS)