Comparative value of Doppler echocardiography and cardiac catheterization for management decision-making in patients with left-sided valvular regurgitation

• Published in: European heart journal 1996-02, Vol.17 (2), p.272-280
• Main Authors: Tribouilloy, C., Shen, W. F., Leborgne, L., Trojette, F., Rey, J.-L., Lesbre, J.-P.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; angiography; aortic regurgitation; Aortic Valve Insufficiency - diagnosis; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - physiopathology; Aortic Valve Insufficiency - therapy; Biological and medical sciences; cardiac catherization; Cardiac Catheterization; Cardiology. Vascular system; Decision Making; Doppler; echocardiography; Echocardiography, Doppler; Echocardiography, Transesophageal; Endocardial and cardiac valvular diseases; Female; Heart; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Mitral regurgitation; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - therapy; Prospective Studies; Ventricular Function, Left
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/oxfordjournals.eurheartj.a014845

Objective The purpose of this study was to examine the value of non-invasive clinical and Doppler echocardio-graphic findings, compared to cardiac catherization, in management decision-making for patients with left-sided valvular regurgitation. Methods One hundred and thirty-five consecutive patients with left-sided valvular regurgitation who underwent cardiac catherization and detailed Doppler echocardiography were prospectively studied. Two independent groups of experienced cardiologists, given clinical information combined with either Doppler echocardiographic or cardiac catherization data, decided to operate, not to operate, or remained uncertain. Results In 63 (81%) of 78 patients with mitral regurgitation, there was agreement on the decision for valve surgery or medical treatment between Doppler echocardiography and cardiac catherization. Valve repair was performed in 22 patients, which agreed with the echocardiographic decision. In the remaining 15 patients, although the severity and type of mitral valve lesions and left ventricular functional status were confirmed by Doppler echocardiography, the clinical decision was uncertain; additional information concerning coronary anatomy (13 patients) and pulmonary artery pressure (one patient) or both (one patient) was required. In 47 of 57 patients (82%) with aortic regurgitation, there was agreement on their management as a result of Doppler echocardiography and cardiac catheterization findings. In 10 patients, the clinical decision reached with the help of Doppler echocardiography alone was uncertain and coronary (seven patients), left ventricular (two patients) angiography or aortography (one patient) were requested. Overall, there were no conflicting clinical decisions made by the two methods in patients with either mitral or aortic regurgitation. Conclusions In every patient in whom it was considered that a decision could be reached by echocardiography alone (more than 80% of patients) there was l00% agreement from the cardiac catherization assessment group on the management decision. Therefore, in patients with significant mitral or aortic regurgitation where echocardiographic data is adequate, cardiac catherization can be safely omitted from the investigative process for surgery. Where echocardiographic indices are conflicting, or significant coronary artery disease is suspected, cardiac catherization is required.