From the Guidelines
Aortic regurgitation is diagnosed through a combination of physical examination, imaging studies, and clinical assessment, with echocardiography being the gold standard diagnostic tool, as recommended by the 2020 ACC/AHA guideline for the management of patients with valvular heart disease 1. The initial diagnosis often begins with auscultation, where a characteristic diastolic murmur can be heard at the left sternal border. Physical examination may also reveal a widened pulse pressure, water-hammer pulse (Corrigan's pulse), and head bobbing (de Musset's sign) in severe cases.
Diagnostic Criteria
The diagnostic criteria for aortic regurgitation include:
- Severity of regurgitation, which can be classified into mild, moderate, and severe, based on parameters such as jet width, vena contracta, regurgitant volume, and regurgitant fraction, as outlined in the 2020 ACC/AHA guideline 1
- Assessment of left ventricular size and function, which is crucial in determining the impact of aortic regurgitation on the heart
- Evaluation of aortic root morphology, which can help identify underlying causes of aortic regurgitation
Imaging Studies
Imaging studies play a crucial role in the diagnosis of aortic regurgitation, with the following modalities being used:
- Echocardiography, which provides visualization of the regurgitant jet, assessment of its severity, measurement of left ventricular dimensions, and evaluation of aortic root morphology
- Transesophageal echocardiography, which may be used when transthoracic images are suboptimal
- Cardiac MRI, which can quantify regurgitant volume and assess left ventricular function, as recommended by the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1
- Cardiac catheterization, which may be performed to evaluate coronary artery disease before surgical intervention
Clinical Assessment
Clinical assessment is also essential in the diagnosis of aortic regurgitation, with the following factors being taken into consideration:
- Symptoms, such as dyspnea, fatigue, and chest pain
- Physical examination findings, such as a widened pulse pressure and water-hammer pulse
- Laboratory tests, which may help identify underlying causes of aortic regurgitation
- Electrocardiogram findings, which may show left ventricular hypertrophy in chronic cases The diagnosis of aortic regurgitation should include assessment of severity based on regurgitant volume, regurgitant fraction, and the impact on left ventricular size and function, as these factors influence treatment decisions and timing of intervention, as recommended by the 2020 ACC/AHA guideline 1.
From the Research
Diagnostic Criteria for Aortic Regurgitation
The diagnostic criteria for aortic regurgitation (aortic valve insufficiency) involve various methods, including:
- Echocardiography: used as the first imaging modality to assess aortic regurgitation (AR) 2
- Cardiac Magnetic Resonance (CMR): provides a comprehensive assessment of AR severity and left ventricular remodeling 2, 3
- Physical examination: clinical examination by cardiologists is accurate for detecting AR, with the presence of an early diastolic murmur being a useful finding for ruling in AR 4
Echocardiographic Evaluation
Echocardiographic evaluation of AR involves:
- Grading AR severity according to American Society of Echocardiography (ASE) guidelines 3
- Quantitation of regurgitant volume (RegV) using pulsed Doppler at the mitral annulus and right ventricular outflow compared with left ventricular outflow 3
- Measurement of vena contracta width and left ventricular end-diastolic volume index (AUC: 0.86-0.89) 3
Diagnostic Accuracy
The diagnostic accuracy of different methods for detecting AR is: