747-4 Evaluation of Regurgitant Jets by Sound Intensity Using a Pulsatile Flow Model: Potential Contribution of Regurgitant Volume and Reynolds Number

Our goal in this study was to determine whether a new type of digital heart sound analysis method could give quantitative information about flow velocity and volume so as to allow a potentially lower-cost approach to followup studies of patients with stenotic or regurgitant valve lesions. To elucidate the relationships between hydrodynamic factors such as Reynolds number, flow velocity and flow volume and the sound characteristics of cardiac murmurs, we developed an in vitro pulsatile flow model with variable orifice size and shape (circular 0.11 cm2, 0.24 cm2, 1.77 cm2and 3.80 cm2; oval 0.24 cm2, with a ratio of major to minor axis=2; rectangular 0.24 cm2, ratio=4). Heart sounds were recorded with a new digital system (MCG) with real time spectral analysis and display and averaged over 15 “cardiac” cycles. Mean flow rate ranged from 0.6 l/min to 6 l/min. Actual instantaneous flow rate was measured using an ultrasonic flow meter for peak flow rates 1.6 l/min to 16.8 l/min. Reynolds number ranged from 6820 to 40050. For each orifice, there was an excellent relationship between total integrated sound energy (See figure: integration of intensity (I) and frequency (F) over time (T).) obtained by digital processing and Reynolds number, peak flow velocity and peak flow rate (r=0.89–0.97, 0.89–0.97, 0.93–D.99, P<0.001, respectively). The best relationship was obtained for the smallest orifice. Higher sound energies were detected for any given flow volume in asymmetrical orifices, probably due to higher turbulence. For all orifices combined, a correlation was found between peak frequency and peak velocity, but only total sound energywas correlated with peak flow rate (r=0.84, P<0.0t). Total integrated sound energy determined digitally is related to peak flow rate; peak velocity and Reynolds number parallel peak sound frequency