What is the role of echocardiography in the workup of aortic regurgitation (AR)?

Updated: Nov 19, 2018
  • Author: Stanley S Wang, JD, MD, MPH; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Transthoracic echocardiography should be performed in all patients with suspected AR, and should be performed periodically in patients with confirmed AR of significant severity. [27]

Echocardiography is a highly accurate test in AR, with sensitivity and specificity well in excess of 90%. In addition, echocardiographic parameters are used to determine the optimal timing of surgery in many cases. [4] Important echocardiographic findings in AR include the following:

  • Aortic valve structure and morphology - Bileaflet versus trileaflet, flail, thickening

  • Presence of vegetations or nodules - May require transesophageal echocardiography in selected cases

  • Severity of AR

  • Color Doppler jet width

  • Vena contracta width - In severe AR, the vena contracta width is usually more than 65% of the width of the LV outflow tract

  • Regurgitant volume, fraction, and orifice area

  • Premature closure of the mitral valve (seen in severe AR) and opening of the aortic valve (with severely elevated LV end-diastolic pressure)

  • Pressure half-time - Usually less than 300-350 ms with significant AR

  • Associated lesions of the aorta - Including dilation, aneurysm, dissection, or ectasia

  • LV structure and function

  • LV hypertrophy and dilation

  • Ejection fraction (EF) and end-systolic dimension - These are key determinants of outcome; surgery is recommended if the EF is 55% or less or if the LV end-systolic dimension is more than 55 mm [4]


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