929 BRIEF REPORTS Color and Pulsed-Wave Domler Studv of Aortic Regurgitation iri systemic- Hypertension CARLO VIGNA, MD ALDO RUSSO, MD MAURO PELLEGRINO SALVATORI, MD FRANCESCO LAURENZI, MD GIANPIERO PERNA, MD ALESSANDRO VILLELLA, MD TOMMASO LANGIALONGA, MD RAFFAELE FANELLI, MD FRANCESCO LOPERFIDO, MD A ortic regurgitation (AR) has been found with vary- ing frequency in patients with systemic hypertension (SH).l The degree of AR in this clinical setting is usual- ly mild.2l3 Although it has been suggested that AR oc- curs in patients with SH as a consequence of the ana- tomic changes of aortic cusps, which are in turn related to both duration and severity of SH,3 no recent study has investigated this. From January to {une 1987, we studied 98 consecu- tive patients with stable SH, 5.2male and 46 female, mean age 56 f 14 years, by color and pulsed-wave From the Department of Cardiology, Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, and the Institute of Cardiology, Universita’ Cattolica de1 Sacro Cuore, Roma, Italy. Manuscript received August 17, 1987; revised manuscript re- ceived November 9,1987. and accepted December 24. Doppler. Each patient had had SH for at least 3 years and had been diagnosed according to World Health Organization criteria. Patients referred for aortic valve disease (regurgitation or stenosis] were excluded from the study. Twenty-seven healthy normotensive subjects, 15 male and 1.2female, mean age 57 f 14 years, constituted the control group. Two-dimension- al echocardiographic and Doppler studies were ob- tained using the Aloka SDS 860 color Doppler system, with 2.5- and 3.5-MHz transducers, by 2 observers unaware of clinical findings. AR was classified as mild and more than mild, according to whether dia- stolic regurgitant turbulence in both long-axis para- sternal and J-chamber or right anterior equivalent apical views4 extended only to left ventricular outflow tract or further into the left ventricle (Figure IA). Dia- stolic turbulence below the aortic cusps was consid- ered suggestive of AR if it lasted the whole diastole, as confirmed by pulsed-wave Doppler analysis (Figure IIB).~ Doppler findings were related to the following clinical data: length of history of SH and highest mea- surements of systolic and diastolic blood pressure, as reported by patient’s physician; systolic and diastolic blood pressure and audibility of AR diastolic murmur at the time of Doppler studies. The following 2-d& mensional echocardiographic data were considered: aortic anulus size, aortic root size and aortic cusp thickening (I or more normally motile echo-dense leaflets). Concentric left ventricular hypertrophy was considered to be present if both left ventricular poste- rior wall and ventricular septum thickness exceeded 12 mm. Isolated hypertrophy of ventricular septum, which may occur in patients with SH,6 was also noted. AR was found in 37 of 98 patients with SH (38%) and 3 of 27 control subjects (11%) (p <O.OOI). AR was FIGURE 1. A, color flow mapplng of aortlc regurgltatlon In right anterior oblique equlvalent aplcal view In a patient with more than mild sys- temlc hypertenslon (extenslon of AR jet Is shown by the computer mark). 6, M-mode color (fop right) and pulsed-wave Doppler (boffom rlghf) analysls In the same patient confirms that turbulent flow below the aortlc cusps lasts the whole dlastole. A0 = aorta; LA = lefl atrium; LV = left ventricle (reproduced In black and white).