ABC | Volume 115, Nº2, August 2020

Original Article Velocity-Time Integral of Aortic Regurgitation: A Novel Echocardiographic Marker in the Evaluation of Aortic Regurgitation Severity José Abellán-Huerta, 1 Juan Carlos Bonaque-González, 1 Ramón Rubio-Patón, 1 José García-Gómez, 1 Santiago Egea-Beneyto, 1 Federico Soria-Arcos, 1 Luciano Consuegra-Sánchez, 1 Rosa María Soto-Ruiz, 1 José Luis Ramos- Martín, 1 Juan Antonio Castillo-Moreno 1 Departamento de Cardiologia, Hospital General Universitario Santa Lucía, 1 Cartagena, Spain Mailing Address: José Abellán-Huerta • Hospital General Universitario de Ciudad Real - Calle Obispo Rafael Torija, s/n Ciudad Real Ciudad Real 13005 – Spain E-mail: doctorabellan@gmail.com Manuscript recived April 11, 2019, revised manuscript June 17, 2019, accepted August 18, 2019 DOI: https://doi.org/10.36660/abc.20190243 Abstract Background: Echocardiography is essential for the diagnosis and quantification of aortic regurgitation (AR). Velocity- time integral (VTI) of AR flow could be related to AR severity. Objective: This study aims to assess whether VTI is an echocardiographic marker of AR severity. Methods: We included all patients withmoderate or severe native AR and sinus rhythmwho visited our imaging laboratory from January to October 2016. All individuals underwent a complete echocardiogram with AR VTI measurement. The association between VTI and AR severity was analyzed by logistic regression and multivariate regression models. A p-value<0,05 was considered statistically significant. Results: Among the 62 patients included (68.5±14.9 years old; 64.5%: moderate AR; 35.5%: severe AR), VTI was higher in individuals with moderate AR compared to those with severe AR (2.2±0.5 m vs. 1.9±0.5 m, p=0.01). Patients with severe AR presented greater values of left ventricular end-diastolic diameter (LVEDD) (56.1±7.1 mm vs. 47.3±9.6 mm, p=0.001), left ventricular end-diastolic volume (LVEDV) (171±36.5 mL vs. 106±46.6 mL, p<0.001), effective regurgitant orifice (0.44±0.1 cm 2 vs. 0.18±0.1 cm 2 , p=0.002), and regurgitant volume (71.3±25.7 mL vs. 42.5±10.9 mL, p=0.05), as well as lower left ventricular ejection fraction (LVEF) (54.1±11.2% vs. 63.2±13.3%, p=0.012). The VTI proved to be a marker of AR severity, irrespective of LVEDD, LVEDV, and LVEF (odds ratio 0.160, p=0.032) and of heart rate and diastolic blood pressure (DBP) (odds ratio 0.232, p=0.044). Conclusions: The VTI of AR flow was inversely associated with AR severity regardless of left ventricular diameter and volume, heart rate, DBP, and LVEF. VTI could be a marker of AR severity in patients with native AR and sinus rhythm. (Arq Bras Cardiol. 2020; 115(2):253-260) Keywords: Heart Failure; Aortic Valve Insufficiency/diagnosis,imaging; Echocardiography, Doppler/methods. Introduction Aortic regurgitation (AR) is one of the most common valvular disorders in the developed world. 1 Typical management of the condition involves a combination of clinical signs and symptoms and data collection through complementary testing. Echocardiography is a key tool for the diagnosis and quantification of AR, 2 and its proper interpretation requires an approach integrating qualitative, semiquantitative, and quantitative measures and parameters. 3,4 However, these parameters are not exempt from limitations. 3 Velocity-time integral (VTI) is defined as the area measured below the Doppler velocity curve at any given point. In the case of AR, its value corresponds to the diastolic pressure gradient between the aorta and the left ventricle (LV). 5 In patients with AR, the VTI is multiplied by the aortic effective regurgitant orifice (ERO) to calculate the regurgitant volume (RV) (RV=EROxVTI). 2,6,7 This parameter has demonstrated its effectiveness in determining AR severity, even though the ERO value is calculated using the proximal isovelocity surface area (PISA) method, which is known to have inherent limitations in patients with AR. 3,8,9 Additionally, taking into account the aforementioned equation, patients with severe AR typically have larger RV 2 and ERO values, 7,10 but there is no evidence of the behavior of VTI in relation to AR severity. Furthermore, patients with severe AR usually present increased end-diastolic pressure in the LV 11 as well as reduced diastolic blood pressure (DBP). 12,13 These pressure changes can 253