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Diagnosing aortic regurgitation: understanding your echocardiogram results

Medically reviewed by

Prof. Vlad Gariboldi

Updated on

August 6, 2026

Your cardiologist has just given you the results of your echocardiogram, filled with numbers and technical terms you may not be familiar with. Or perhaps you are wondering if the tests performed so far are sufficient to properly assess your situation. Diagnosing aortic regurgitation relies on specific parameters, and their interpretation directly influences future decisions.

Key points

  • The discovery of a heart murmur during auscultation is often the first sign that leads to a Doppler echocardiogram, the gold-standard test for confirming the diagnosis.
  • The echocardiogram measures the severity of the leak using several combined parameters: regurgitant volume, left ventricular size, and ejection fraction (the percentage of blood actually pumped out with each beat).
  • Grading severity is not always straightforward: several parameters may yield conflicting results, which can make interpretation complex at times.
  • Additional tests (exercise stress test, cardiac MRI, coronary angiography) may be necessary depending on the situation, particularly before a surgical decision is made.

From auscultation to echocardiography: the diagnostic process

The diagnostic journey often begins with a general practitioner or during a routine check-up: a murmur detected during auscultation leads to a cardiology consultation. While this murmur is characteristic of an aortic leak, it is not enough on its own to assess its severity. An electrocardiogram (ECG) and a chest X-ray may be performed as a first step; they provide information on the impact on the heart but do not confirm the diagnosis.

Atransthoracic Doppler echocardiogram (performed over the chest wall, without any invasive procedure) is the gold-standard test. It allows for direct visualization of the aortic valve, measurement of the regurgitant flow (the volume of blood flowing back into the left ventricle with each beat), and assessment of the impact on the heart muscle. It is based on this exam that the severity of the aortic regurgitation is graded.

Mild, moderate, severe: what echocardiogram numbers mean

Grading aortic regurgitation relies on a combination of several parameters measured during the echocardiogram. No single number is sufficient: it is the combination of these values that determines the severity.

Key parameters:

  • Regurgitant volume: the volume of blood that flows back into the left ventricle with each beat, expressed in milliliters.
  • Regurgitant orifice area: the effective leak size, expressed in cm².
  • Left ventricular diameter: the dilation of the ventricle in response to the overload, measured in millimeters.
  • Ejection fraction: the portion of blood actually pumped out with each contraction, expressed as a percentage.

These parameters allow aortic regurgitation to be classified into three grades:

  • Mild: minor leak, minimal impact on the left ventricle, routine monitoring.
  • Moderate: significant leak, intermediate impact, close follow-up.
  • Severe: major leak with impact on the left ventricle; this is the stage where criteria for surgical intervention come into play.

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In cases where echocardiographic parameters are inconsistent, a second opinion from a cardiologist specializing in valvular heart disease can help clarify the situation before making a decision.

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When additional tests are needed to complete the assessment

Depending on the clinical presentation and ultrasound results, additional tests may be ordered to refine the evaluation.

  • Exercise stress test: used to uncover symptoms in a patient who reports being asymptomatic. Physical exertion can reveal exercise intolerance that is not apparent at rest, helping to guide the follow-up strategy.
  • Cardiac MRI: indicated in complex cases, particularly when there is a discrepancy between echocardiographic parameters or to precisely assess myocardial fibrosis (the heart muscle). It can supplement or confirm ultrasound findings.
  • Coronary angiography: performed as part of a pre-operative assessment in certain patients to evaluate the condition of the coronary arteries before potential surgery. It is not performed systematically.

The choice of these additional tests is evaluated on a case-by-case basis as part of the specialized diagnostic process.

Frequently Asked Questions

Which test is used to diagnose aortic regurgitation?

Transthoracic Doppler echocardiography is the gold standard for confirming the diagnosis and assessing severity. A heart murmur detected during auscultation points toward this test, but is not sufficient to establish a diagnosis.

Mild, moderate, and severe aortic regurgitation: what is the difference?

Grading is based on several echocardiographic parameters (regurgitant volume, left ventricular size, ejection fraction). The higher the severity, the more relevant the criteria for potential surgical intervention become.

Is a heart murmur enough to diagnose aortic regurgitation?

A murmur is an indicator, not a diagnosis. Only a Doppler echocardiogram can confirm aortic regurgitation, visualize its cause, and measure its severity.

Is a cardiac MRI needed to confirm a diagnosis of aortic regurgitation?

A cardiac MRI is not routine; an echocardiogram is sufficient in most cases. It is indicated in complex situations, particularly when there is a discrepancy between echocardiographic parameters or to provide a more detailed assessment of the heart muscle.

How do I know if my aortic regurgitation is getting worse?

Worsening is primarily detected by comparing results from successive echocardiograms: changes in left ventricular diameter, ejection fraction, and regurgitant volume. The onset or worsening of symptoms is also an important sign to discuss with your cardiologist.

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Sources

  1. French Society of Cardiology (SFCardio), Chapter 08 – Item 233: Valvular Heart Disease
  2. Bordeaux University Hospital, Aortic Regurgitation

Did you know?

The Valvular Heart Disease chapter of the French Society of Cardiology notes that the severity classification of aortic regurgitation is based on the combination of several criteria, the individual values of which may vary depending on examination conditions. In the event of a discrepancy between parameters, the classification becomes uncertain and requires in-depth expert analysis.

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When facing cancer or a serious illness, every decision counts.

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What is a medical second opinion?

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What is a medical second opinion?

Following a diagnosis or a proposed treatment plan, a medical specialist can analyze your file and provide an additional perspective.

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Your health insurance may cover your second opinion.

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Your health insurance may cover your second opinion.

Many partner health insurance providers cover the Diagdoor service with no upfront costs. Check your eligibility as soon as you create your account.

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Are you looking for a second opinion for a loved one?

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The process is entirely online. Upload your available medical documents, and our team will take care of the rest.

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How does a second opinion work on Diagdoor?

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How does a second opinion work on Diagdoor?

Upload your medical documents online; our team will review your file within 48 hours, and an expert will provide their opinion in less than 7 days. Simple, secure, 100% online.

See how it works

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