The presence of certain findings determined by 2-dimensional echocardiography may indicate a risk for adverse outcomes in a patient with asymptomatic mitral regurgitation. Donovan and Starling developed an algorithm to help decide if the level of risk posed by these factors is sufficient to justify surgery or not.
Parameters:
(1) percent fractional shortening
(2) end-systolic volume index in mL per square meter BSA
(3) end systolic wall stress in mm Hg
(4) end-diastolic wall dimension in mm
(5) Doppler dP/dt of mitral regurgitant jet
(6) right ventricular ejection fraction in percent
Parameter
Finding
Points
percent fractional shortening
>= 31%
0
< 31%
2
end systolic volume index
<= 30 mL per square m
0
> 30 mL per square m
2
end systolic wall stress
<= 195 mm Hg
0
> 195 mm Hg
2
end diastolic wall dimension
<= 70 mm
0
> 70 mm
2
Doppler dP/dt of mitral regurgitant jet
>= 1,343 mm Hg/s
0
< 1,343 mm Hg/s
2
right ventricular ejection fraction in percent
>= 30%
0
< 30%
2
total score for adverse outcome =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the risk for an adverse outcome.
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