Detection of mild aortic regurgitation by range-gated pulsed doppler echocardiography

In order to assess the sensitivity and specificity of the range-gated pulsed Doppler echocardiogram for the detection of aortic regurgitation, a study with use of this technique was carried out in 46 patients. They were classified into 3 groups: Group I was composed of 19 patients with a variety of heart diseases but with a competent aortic valve. Cardiac catheterization revealed no aortic regurgitation in any of the 19 patients, and the Doppler echocardiogram detected no turbulent diastolic flow in the left ventricular outflow tract. Group II was composed of 17 patients who clinically and by auscultation had aortic regurgitation, which was confirmed by cardiac catheterization in 6. In all 17 patients the Doppler echocardiogram detected several grades of turbulent diastolic flow compatible with aortic regurgitation in the left ventricular outflow tract. Group III was composed of 10 patients with aortic regurgitation but without the expected clinical or auscultatory evidence. The echocardiogram detected mitral valve flutter in only 1 patient. Cardiac catheterization revealed aortic regurgitation graded $\text{1}\text{4}$ and $\text{2}\text{4}$ in 9 patients, and the patient who did not undergo catheterization had a murmur of aortic insufficiency 6 months later. In all 10 patients the Doppler echocardiogram detected a regurgitating turbulent flow compatible with aortic regurgitation in the left ventricular outflow tract.It is concluded that the Doppler echocardiogram was more useful than auscultation and echocardiography for the detection of mild aortic regurgitation. In this study the range-gated pulsed Doppler echocardiogram proved 100% sensitive and specific. However, it will be necessary to study larger groups in order to assess its utility in more complicated conditions (obesity, emphysema, and heart failure) and the differential diagnosis with other diastolic murmurs.