Visual Assessment of Valvular Regurgitation: Comparison With Quantitative Doppler Measurements

To investigate which factors influence visual evaluation and how accurate it is in patients with valvular insufficiency, 83 patients were studied. All were in sinus rhythm, 43 with mitral and 40 with tricuspid regurgitation. Categoric visual grading (mild, moderate, and severe) was compared with jet area method and regurgitant fraction and the factors that influenced the assigned rank were identified. With jet area method (mean of areas in three planes), the correlation with regurgitant fraction was r = 0.61 for free jets and r = 0.32 for wall jets (overall r = 0.47) in patients with mitral regurgitation, and r = 0.81 and r = 0.46 for free and wall jets, respectively, in patients with tricuspid regurgitation (overall, r = 0.65). With visual grading, the correlation was for free and wall jets, respectively, ρ = 0.80 and ρ = 0.74 (overall ρ = 0.76) in patients with mitral regurgitation, and ρ = 0.79 and ρ = 0.49 for free and wall jets, respectively (overall ρ = 0.62), in patients with tricuspid regurgitation. The jet area parameter found to have the most influence on visual grading was the average area in three planes divided by atrial area, with ρ = 0.80 and ρ = 0.51 in patients with mitral regurgitation (free and impinging jets respectively) and ρ = 0.60 and ρ = 0.46 in tricuspid regurgitation. We conclude that visual grading of valvular regurgitant jets correlates well with quantitative measures of valvular incompetence and better than any simple jet area method. Integrating additional information available from two-dimensional and Doppler images allows an accurate assessment of distorted wall jets in mitral regurgitation, but in tricuspid regurgitation the visual evaluation of impinging jets is less accurate.