What is the role of the Doppler-based VTI ratio in regurgitation assessment?

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Doppler-based VTI ratio is used to quantify regurgitation by comparing how far blood travels during systole in the regurgitant stream versus in the forward, non-regurgitant flow. The velocity-time integral (VTI) reflects the distance blood travels in a given beat, so taking the VTI of the regurgitant jet and dividing by the VTI of forward flow (for example, LVOT flow in mitral regurgitation) provides an index of how much stroke volume is leaking backward. A higher ratio indicates more regurgitant flow and greater severity, and this value is used as part of quantitative estimates of regurgitant volume and regurgitant fraction, in combination with other measurements. It isn’t used to measure pressures (right ventricular systolic pressure or left atrial pressure) or to assess LV ejection fraction, which reflects systolic function rather than the amount of regurgitation.