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Evaluation of the Integrative Algorithm for Grading Chronic Aortic and Mitral Regurgitation Severity Using the Current American Society of Echocardiography Recommendations: To Discriminate Severe from Moderate Regurgitation.

Journal article
Authors Sinsia Gao
Christian Lars Polte
Kerstin M Lagerstrand
Åse (Allansdotter) Johnsson
Odd Bech-Hanssen
Published in Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
Volume 31
Issue 9
Pages 1002-1012.e2
ISSN 1097-6795
Publication year 2018
Published at Institute of Clinical Sciences, Department of Radiation Physics
Institute of Clinical Sciences, Department of Radiology
Institute of Medicine, Department of Molecular and Clinical Medicine
Pages 1002-1012.e2
Language en
Keywords Aortic regurgitation, Mitral regurgitation, ASE recommendations, ASE algorithm, Echocardiography, Cardiovascular magnetic resonance
Subject categories Cardiovascular medicine


The recently published integrative algorithms for echocardiographic grading of native aortic regurgitation (AR) and mitral regurgitation (MR) by the American Society of Echocardiography are consensus based and have not been evaluated. Thus, the aims of the present study were to investigate the feasibility of individual parameters and to evaluate the ability of the algorithms to discriminate severe from moderate regurgitation.This prospective study comprised 93 patients with chronic AR (n = 45) and MR (n = 48). All patients underwent echocardiography and cardiovascular magnetic resonance within 4 hours. The algorithms were evaluated using two different definitions for severe regurgitation: (1) a cardiovascular magnetic resonance standard indicating future need for valve surgery and (2) a clinical standard using patients who underwent valve surgery with proven postoperative left ventricular reverse remodeling and improved functional class (AR/MR, n = 26/26).The feasibility of the criteria in the first step of the algorithm was higher (AR/MR, 95%/91%) compared with the second step using quantitative Doppler parameters (74%/57%). For the AR algorithm, sensitivity was 95% and specificity 44%, whereas for the MR algorithm, sensitivity was 73% and specificity 92%. Among patients with benefit of surgery, the algorithms correctly identified 77%, misclassified 8%, and were inconclusive in 15% of the patients with AR; the corresponding figures were 73%, 15%, and 12% in the patients with MR.Using cardiovascular magnetic resonance as reference, the recommended algorithms for grading of regurgitation have the ability to rule out severe AR and rule in severe MR. The quantitative Doppler methods are hampered by feasibility issues, and our findings suggest that the decision regarding surgical intervention in symptomatic patients with discordant or inconclusive echocardiographic grading should be based on a consolidated assessment of clinical and multimodality findings.

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