Calibration of color Doppler flow mapping during extreme hemodynamic conditions in vitro: a foundation for a reliable quantitative grading system for aortic incompetence.

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Abstract
If color Doppler imaging is to continue to evolve into a reliable clinical method to noninvasively evaluate regurgitant lesions, then its grading methods must be quantitated and calibrated under extreme hemodynamic conditions. A left heart pulse duplicator was used to provide a completely controllable system to study aortic incompetence jet morphologies as a function of hemodynamic extremes. The system was first used to calibrate the limits of resolution of color Doppler imaging. Next, to define which jet features reliably predict the defect size or the regurgitant fraction and which are primarily influenced by instantaneous hemodynamic variables, we measured the jets' maximal length, width, proximal width, and temporal pattern of color variance during independent variations in the heart rate, cardiac output, and pressure gradient across the incompetent valve. The proximal jet width (immediately below the valve plane) was the only reliable independent predictor of both the defect size and the regurgitant fraction. Jet depth accurately predicted peak velocity (quantitated by laser Doppler velocimetry); it reliably predicted the severity of incompetence only at a known pressure gradient across the valve. Large defects (5 mm) produced jets with maximal color variance in early diastole, whereas small defects produced pandiastolic variance.