Value of qualitative angiographic grading in aortic regurgitation

The aim of this study was to assess the accuracy of angiographic grading of regurgitation in patients with aortic regurgitation (AR). In 204 adult patients (149 men, 55 women, aged 51 +/- 13 years) with AR, the forward cardiac index was measured by the indicator dilution technique, and the left ventricular angiographic index by the area length method, from which the regurgitant stroke index and the percentage of regurgitation were calculated. In 80 other patients without regurgitation, there was a good correlation between forward and angiographic cardiac indices (r = 0.83, P less than 0.001). Aortic regurgitation graded on a 1-4 scale was, in the 204 patients with AR, correlated with the percentage and the volume of regurgitation (respectively r = 0.87, P less than 0.001 and r = 0.92, P less than 0.001). The regurgitant stroke index and the percentage of regurgitation were significantly different from one group to another (P less than 0.001). However, there was a range in amount of regurgitation within each grade and an overlap from one grade to another. There were no differences in regurgitant stroke index or in the percentage of regurgitation when patients were categorized according to LV end-diastolic or endsystolic volume, LV ejection fraction, forward cardiac index or intracardiac pressure.