Severity of aortic regurgitation assessed by area of vena contracta: a clinical two-dimensional and three-dimensional color Doppler imaging study

Hirotomo Sato, Tetsuro Ohta, Kimiko Hiroe, Seiji Okada, Koji Shimizu, Rinji Murakami, Kazuaki Tanabe

Quantitation of aortic regurgitation (AR) using two-dimensional (2D) echocardiography, including vena contracta width (VCW) measurement, is still challenging. Three-dimensional (3D) echocardiography can directly measure the vena contracta area (VCA), regardless of the rheological characteristics. We intended to assess the possibility of 3D vena contracta area (3DVCA) as well as 2D vena contracta area (2DVCA) in the assessment of AR severity. Sixty-one patients with AR [17 female (32.7%); mean age: 74.0 ± 10.1 years] underwent 2D and 3D color Doppler echocardiography. Using conventional 2D color Doppler imaging, we measured VCW, 2DVCA, regurgitant volume (RV), and effective regurgitant orifice area (EROA). We also measured 3DVCA manually off-line from 3D full-volume color Doppler datasets for reference. Comprehensive 2D and 3D data on AR severity were successfully obtained from 52 of the 61 (85.2%) patients. Significant correlations existed between 2DVCA and EROA (r = 0.89; p < 0.001). The cut-off 2DVCA for grading severe AR was 34 mm(2) (area under curve: 0.95; sensitivity: 78%; specificity: 95%). Significant correlations existed between 3DVCA and EROA (r = 0.89; p < 0.001). The cut-off 3DVCA for grading severe AR was 32 mm(2) (area under curve: 0.96; sensitivity: 89%; specificity: 98%). Significant correlations existed between 2DVCA and 3DVCA (r = 0.96; p < 0.001). Two-dimensional, as well as three dimensional, vena contracta area measurement is a simple technique suitable for clinical use during comprehensive Doppler echocardiographic AR assessment.