Diagnostic performance of semi-quantitative echocardiographic evaluation in patients with aortic regurgitation: implications for clinical practice

Abstract Background In current practice, screening for severe aortic regurgitation (AR) relies on qualitative and semi-quantitative echocardiographic parameters. No information is given on the diagnostic performance of each of these parameters. Objectives The purpose of this study was to investigate the diagnostic performance of semi-quantitative echocardiographic parameters in discriminating moderate from severe AR. Methods This single-center retrospective cohort study included 102 consecutive patients with chronic isolated moderate or severe AR. Patients were divided between severe and moderate AR using a combination of left ventricle (LV) dilatation, Proximal Isovelocity Surface Area (PISA) echocardiographic method and cardiovascular magnetic resonance (CMR). Receiver operator characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of vena contracta width (VC), pressure half-time (PHT) and diastolic flow reversal in descending aorta (DFR). Results Threshold value VC > 6mm provided a low sensitivity (40.4%) and an excellent 88.9% specificity for the diagnosis of severe AR. For PHT, the value < 200ms provided a poor sensitivity (2.0%) and an excellent 100% specificity. For DFR, the value ≥ 0.2m/s provided a low sensitivity (37.8%) and a good 78.6% specificity. These 3 parameters have a good positive predictive value (PPV) > 80% and a poor negative predictive value (NPV) < 40%. The area under the curve for the diagnosis of severe AR was 0.72, 0.72 and 0.59 for VC, PHT and DFR, respectively. Conclusion Our study demonstrates that the semi-quantitative parameters VC, PHT and DFR are highly specific but poorly sensitive for diagnosing severe chronic AR. They can rule in severe AR but in presence of intermediate values, they are insufficient to rule out severe AR.Venn diagramDiagnostic performance