Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance.

Full Abstract

OBJECTIVES: The aim of this study was to evaluate feasibility and accuracy of real-time 3-dimensional (3D) echocardiography for quantification of mitral regurgitation (MR), in a head-to-head comparison with velocity-encoded cardiac magnetic resonance (VE-CMR). BACKGROUND: Accurate grading of MR severity is crucial for appropriate patient management but remains challenging. VE-CMR with 3D three-directional acquisition has been recently proposed as the reference method. METHODS: A total of 64 patients with functional MR were included. A VE-CMR acquisition was applied to quantify mitral regurgitant volume (Rvol). Color Doppler 3D echocardiography was applied for direct measurement, in "en face" view, of mitral effective regurgitant orifice area (EROA); Rvol was subsequently calculated as EROA multiplied by the velocity-time integral of the regurgitant jet on the continuous-wave Doppler. To assess the relative potential error of the conventional approach, color Doppler 2-dimensional (2D) echocardiography was performed: vena contracta width was measured in the 4-chamber view and EROA calculated as circular (EROA-4CH); EROA was also calculated as elliptical (EROA-elliptical), measuring vena contracta also in the 2-chamber view. From these 2D measurements of EROA, the Rvols were also calculated. RESULTS: The EROA measured by 3D echocardiography was significantly higher than EROA-4CH (p < 0.001) and EROA-elliptical (p < 0.001), with a significant bias between these measurements (0.10 cm(2) and 0.06 cm(2), respectively). Rvol measured by 3D echocardiography showed excellent correlation with Rvol measured by CMR (r = 0.94), without a significant difference between these techniques (mean difference = -0.08 ml/beat). Conversely, 2D echocardiographic approach from the 4-chamber view significantly underestimated Rvol (p = 0.006) as compared with CMR (mean difference = 2.9 ml/beat). The 2D elliptical approach demonstrated a better agreement with CMR (mean difference = -1.6 ml/beat, p = 0.04). CONCLUSIONS: Quantification of EROA and Rvol of functional MR with 3D echocardiography is feasible and accurate as compared with VE-CMR; the currently recommended 2D echocardiographic approach significantly underestimates both EROA and Rvol.

Author information

Author/s: Marsan, Nina Ajmone (NA); Westenberg, Jos J M (JJ); Ypenburg, Claudia (C); Delgado, Victoria (V); van Bommel, Rutger J (RJ); Roes, Stijntje D (SD); Nucifora, Gaetano (G); van der Geest, Rob J (RJ); de Roos, Albert (A); Reiber, Johan C (JC); Schalij, Martin J (MJ); Bax, Jeroen J (JJ);

Affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: JACC. Cardiovascular imaging (JACC Cardiovasc Imaging), published in United States. (Language: eng)

Reference: 2009-Nov; vol 2 (issue 11) : pp 1245-52

Dates: Created 2009/11/13;

PMID: 19909927, status: In-Process (last retrieved date: 11/16/2009)

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