Intensity of murmurs correlates with severity of valvular regurgitation

Am J Med. 1996 Feb;100(2):149-56. doi: 10.1016/s0002-9343(97)89452-1.


Purpose: To evaluate the relationship between the intensity of murmurs and severity of mitral and aortic regurgitation.

Patients and methods: Consecutive patients with chronic isolated aortic (n = 40) or mitral (n = 170) regurgitation undergoing echocardiographic quantitation of regurgitation between 1990 and 1991 were studied. Regurgitant volume and fraction were measured using two simultaneous methods (quantitative Doppler echocardiography and quantitative two-dimensional echocardiography); the intensity of the regurgitant murmur (grade 0 to 6) was noted by physicians unaware of the study.

Results: Correlations between murmur intensity and regurgitant volume and fraction were good in aortic regurgitation (r = .60 and r = .67, respectively; P < 0.001) and mitral regurgitation (r = .64 and r = .67, respectively; P < 0.001) but weaker (r = .47 and r = .45, respectively) in the subset of mitral regurgitation of ischemic or functional cause. Murmur intensity grades > or = 3 for aortic regurgitation and > or = 4 for mitral regurgitation predicted severe regurgitation (regurgitant fraction > or = 40%) in 71% and 91% of patients, respectively. Murmur grades < or = 1 for aortic regurgitation and < or = 2 for mitral regurgitation predicted "not severe" regurgitation in 100% and 88% of patients, respectively. Murmur grades 2 for aortic regurgitation and 3 for mitral regurgitation were not correlated to degree of regurgitation. The severity of regurgitation was the most powerful determinant of intensity of murmur.

Conclusions: Murmur intensity correlates well with the degree of chronic organic aortic and mitral regurgitation, and can be used as a predictor of regurgitation severity and as a simple guideline for diagnostic testing in these patients.

MeSH terms

  • Aged
  • Aortic Valve Insufficiency / complications*
  • Aortic Valve Insufficiency / diagnostic imaging
  • Echocardiography
  • Female
  • Heart Murmurs / complications*
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve Insufficiency / complications*
  • Mitral Valve Insufficiency / diagnostic imaging
  • Prospective Studies
  • Severity of Illness Index