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Slostad B, Ayuba G, Puthumana JJ. Primary Mitral Regurgitation and Heart Failure: Current Advances in Diagnosis and Management. Heart Fail Clin 2023; 19:297-305. [PMID: 37230645 DOI: 10.1016/j.hfc.2023.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Primary mitral regurgitation is a frequent etiology of congestive heart failure and is best treated with intervention when patients are symptomatic or when additional risk factors exist. Surgical intervention improves outcomes in appropriately selected patients. However, for those at high surgical risk, transcatheter intervention provides less invasive repair and replacement options while providing comparable outcomes to surgery. The excess mortality and high prevalence of heart failure in untreated mitral regurgitation illuminate the need for further developments in mitral valve intervention ideally fulfilled by expanding these types of procedures and eligibility to these procedures beyond only those at high surgical risk.
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Affiliation(s)
- Brody Slostad
- Bluhm Cardiovascular Institute, Northwestern University, 675 North St Clair Street Ste 19-100, Galter Pavilion, Chicago, IL 60611, USA
| | - Gloria Ayuba
- Bluhm Cardiovascular Institute, Northwestern University, 675 North St Clair Street Ste 19-100, Galter Pavilion, Chicago, IL 60611, USA
| | - Jyothy J Puthumana
- Bluhm Cardiovascular Institute, Northwestern University, 675 North St Clair Street Ste 19-100, Galter Pavilion, Chicago, IL 60611, USA.
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2
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Altes A, Vermes E, Levy F, Vancraeynest D, Pasquet A, Vincentelli A, Gerber BL, Tribouilloy C, Maréchaux S. Quantification of primary mitral regurgitation by echocardiography: A practical appraisal. Front Cardiovasc Med 2023; 10:1107724. [PMID: 36970355 PMCID: PMC10036770 DOI: 10.3389/fcvm.2023.1107724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.
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Affiliation(s)
- Alexandre Altes
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Franck Levy
- Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - André Vincentelli
- Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Bernhard L. Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | | | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Correspondence: Sylvestre Maréchaux
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Lozano-Edo S, Jover-Pastor P, Osa-Saez A, Buendia-Fuentes F, Rodriguez-Serrano M, Arnau-Vives MA, Rueda-Soriano J, Calvillo-Batlles P, Fonfria-Esparcia C, Martinez-Dolz L, Agüero J. Spatiotemporal Complexity of Vena Contracta and Mitral Regurgitation Grading Using Three-Dimensional Echocardiographic Analysis. J Am Soc Echocardiogr 2023; 36:77-86.e7. [PMID: 36208654 DOI: 10.1016/j.echo.2022.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Spatiotemporal complexity of the color Doppler vena contracta challenging the assumption of a circular and constant orifice may lead to mitral regurgitation (MR) grading inconsistencies. Using 3D transesophageal echocardiography, we characterized spatiotemporal vena contracta complexity and its impact on MR severity grading. METHODS In 192 patients with suspected moderate or severe MR (100 primary MR [PMR]; 92 secondary MR [SMR]), we performed three-dimensional vena contracta area (VCA) quantification using single-frame (midsystolic or VCAmid, maximum or VCAmax) and multiframe (VCAmean) methods, as well as measures of orifice shape (shape index) and systolic variation of VCA. Vena contracta complexity and intermethod discrepancies were analyzed and correlated with functional class and pulmonary vein flow (PVF) patterns and with cardiac magnetic resonance (CMR) in a subset of cases (n = 20). RESULTS The vena contracta was noncircular (shape index > 1.5) in 90% of patients. Severe noncircularity (shape index > 3) was more prevalent in SMR than in PMR (32.4% vs 14.6%). Variations of the VCA were more prominent in SMR than in PMR. VCAmid showed a low grading agreement with VCAmax (62%) and high grading agreement with VCAmean (83.3%). Pulmonary vein flow systolic reversal was associated with MR severity by VCA in SMR but not in PMR. VCAmid and VCAmean showed a stronger association with systolic flow reversal than VCAmax (area under the curve, 0.88, 0.86, and 0.79, respectively). In the subset of patients with CMR quantification, severe MR by VCAmax was graded as nonsevere by CMR more frequently compared with VCAmid and VCAmean. CONCLUSIONS Highly prevalent spatiotemporal vena contracta complexity features in MR challenge the assumption of a circular and constant orifice. VCAmid seems the best single-frame approximation to multiframe quantification, and VCAmax may lead to severity overestimation.
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Affiliation(s)
| | | | - Ana Osa-Saez
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Francisco Buendia-Fuentes
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Maria Rodriguez-Serrano
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel Angel Arnau-Vives
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Joaquin Rueda-Soriano
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Luis Martinez-Dolz
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jaume Agüero
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Gajjar K, Kashyap K, Badlani J, Williams RB, Biederman RWW. A review of the pivotal role of cardiac MRI in mitral valve regurgitation. Echocardiography 2020; 38:128-141. [PMID: 33270944 DOI: 10.1111/echo.14941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023] Open
Abstract
Cardiac imaging is the cornerstone of defining the etiology, quantification, and management of mitral regurgitation (MR). This continues to be even more so the case with emerging transcatheter techniques to manage MR. Transthoracic echocardiography remains the first-line imaging modality to assess MR but has limitations. Cardiac MRI(CMR) provides the advantages of quantitative nonvisual estimation, 3D volumetric data, late gadolinium, T1, and extracellular volume measurements to comprehensively assess mitral valvular pathology, cardiac remodeling, and the prognostic impact of therapies. This review describes the superiority, technical aspects and growing evidence behind CMR, and lays the roadmap for the future of CMR in MR.
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Affiliation(s)
- Kushani Gajjar
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Kartikeya Kashyap
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Jayshiv Badlani
- Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Ronald B Williams
- Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA
| | - Robert W W Biederman
- Department of Cardiology, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA.,Department of Cardiovascular Magnetic Resonance Imaging, Allegheny General Hospital- Allegheny Health Network, Pittsburgh, PA, USA.,Drexel University, Philadelphia, PA, USA.,Bioengineering Department, Carnegie Mellon University, Pittsburgh, PA, USA
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Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P, Hahn R, Han Y, Hung J, Lang R, Little S, Shah D, Shernan S, Thavendiranathan P, Thomas J, Weissman N. Recommendations for noninvasive evaluation of native valvular regurgitation
A report from the american society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Fabbro M, Aljure OD, Jain P. Predicting the Number of Edge-to-Edge Repair Devices Needed to Adequately Treat Mitral Regurgitation Using Transesophageal Echocardiography. J Cardiothorac Vasc Anesth 2019; 33:2647-2651. [PMID: 31320261 DOI: 10.1053/j.jvca.2019.05.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Increased utilization and highly variable costs seen with percutaneous mitral valve edge-to-edge repair have made cost cutting strategies of significant interest. Mitral regurgitation etiology, the number of devices used, and experience all play a role in variability. Currently a paucity of data exists in predicting the number of devices. Any associations found between echocardiography parameters and the number of devices used could help with pre-procedure planning and device placement strategies, ultimately reducing variability and costs. DESIGN In this retrospective analysis the authors evaluated the ability of established and novel three-dimensional (3D) mitral regurgitation measures, namely 3D vena contracta area and vena contracta length, to predict the number of devices used. Other factors evaluated include mitral valve area and ejection fraction. All factors were compared using the Mann Whitney rank sum tests. PARTICIPANTS Patients over 18 years old undergoing the MitraClip procedure. SETTING Catheterization Laboratory. MAIN RESULTS No relationship was found between 3D parameters and the number of devices used, but mitral valve area was strongly associated with the use of multiple devices. CONCLUSION The 3D parameters of interest were not associated with the use of multiple devices, but the mitral valve area was associated. Further studies are needed to determine if this relationship is predictive.
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Affiliation(s)
- Michael Fabbro
- University of Miami Miller School of Medicine, Miami, FL.
| | - Oscar D Aljure
- University of Miami Miller School of Medicine, Miami, FL
| | - Pankaj Jain
- University of Miami Miller School of Medicine, Miami, FL
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Chew PG, Bounford K, Plein S, Schlosshan D, Greenwood JP. Multimodality imaging for the quantitative assessment of mitral regurgitation. Quant Imaging Med Surg 2018; 8:342-359. [PMID: 29774187 DOI: 10.21037/qims.2018.04.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural history of mitral regurgitation (MR) results in significant morbidity and mortality. Innovations in non-invasive imaging have provided new insights into the pathophysiology and quantification of MR, in addition to early detection of left ventricular (LV) dysfunction and prognostic assessment in asymptomatic patients. Transthoracic (TTE) and transesophageal (TOE) echocardiography are the mainstay for diagnosis, assessment and serial surveillance. However, the advance from 2D to 3D imaging leads to improved assessment and characterization of mitral valve (MV) disease. Cardiovascular magnetic resonance (CMR) is increasingly used for MR quantitation and can provide an alternative imaging method if echocardiography is suboptimal or inconclusive. Other techniques such as exercise echocardiography, tissue Doppler imaging and speckle-tracking echocardiography can further offer complementary information on prognosis. This review summarises the current evidence for state-of-the-art cardiovascular imaging for the investigation of MR. Whilst advanced echocardiographic techniques are superior in the evaluation of complex MV anatomy, CMR appears the most accurate technique for the quantification of MR severity. Integration of multimodality imaging for the assessment of MR utilises the advantages of each imaging technique and offers the most comprehensive assessment of MR.
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Affiliation(s)
- Pei G Chew
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
| | | | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre (MCRC) & Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM), University of Leeds, Leeds, UK
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Dietl A, Prieschenk C, Eckert F, Birner C, Luchner A, Maier LS, Buchner S. 3D vena contracta area after MitraClip© procedure: precise quantification of residual mitral regurgitation and identification of prognostic information. Cardiovasc Ultrasound 2018; 16:1. [PMID: 29310672 PMCID: PMC5759791 DOI: 10.1186/s12947-017-0120-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Percutaneous mitral valve repair (PMVR) is increasingly performed in patients with severe mitral regurgitation (MR). Post-procedural MR grading is challenging and an unsettled issue. We hypothesised that the direct planimetry of vena contracta area (VCA) by 3D-transoesophageal echocardiography allows quantifying post-procedural MR and implies further prognostic relevance missed by the usual ordinal scale (grade I-IV). METHODS Based on a single-centre PMVR registry containing 102 patients, the association of VCA reduction and patients' functional capacity measured as six-minute walk distance (6 MW) was evaluated. 3D-colour-Doppler datasets were available before, during and 4 weeks after PMVR. RESULTS Twenty nine patients (age 77.0 ± 5.8 years) with advanced heart failure (75.9% NYHA III/IV) and severe degenerative (34%) or functional (66%) MR were eligible. VCA was reduced in all patients by PMVR (0.99 ± 0.46 cm2 vs. 0.22 ± 0.15 cm2, p < 0.0001). It remained stable after median time of 33 days (p = 0.999). 6 MW improved after the procedure (257.5 ± 82.5 m vs. 295.7 ± 96.3 m, p < 0.01). Patients with a decrease in VCA less than the median VCA reduction showed a more distinct improvement in 6 MW than patients with better technical result (p < 0.05). This paradoxical finding was driven by inferior results in very large functional MR. CONCLUSIONS VCA improves the evaluation of small residual MR. Its post-procedural values remain stable during a short-term follow-up and imply prognostic information for the patients' physical improvement. VCA might contribute to a more substantiated estimation of treatment success in the heterogeneous functional MR group.
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Affiliation(s)
- Alexander Dietl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany. .,Comprehensive Heart Failure Center Würzburg, University Hospital and University of Würzburg, Würzburg, Germany.
| | - Christine Prieschenk
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Franziska Eckert
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Andreas Luchner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany.,Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany
| | - Stefan Buchner
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, D-93053, Regensburg, Germany.,Department of Internal Medicine II, Sana Kliniken Cham, Cham, Germany
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Abudiab MM, Chao CJ, Liu S, Naqvi TZ. Quantitation of valve regurgitation severity by three-dimensional vena contracta area is superior to flow convergence method of quantitation on transesophageal echocardiography. Echocardiography 2017; 34:992-1001. [DOI: 10.1111/echo.13549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Muaz M. Abudiab
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
| | - Chieh-Ju Chao
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
| | - Shuang Liu
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
| | - Tasneem Z. Naqvi
- Echocardiography Laboratory; Department of Cardiovascular Diseases; Mayo Clinic; Scottsdale AZ USA
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Naoum C, Blanke P, Cavalcante JL, Leipsic J. Cardiac Computed Tomography and Magnetic Resonance Imaging in the Evaluation of Mitral and Tricuspid Valve Disease. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005331. [DOI: 10.1161/circimaging.116.005331] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transcatheter interventions to treat mitral and tricuspid valve disease are becoming increasingly available because of the growing number of elderly patients with significant comorbidities or high operative risk. Thorough clinical and imaging evaluation in these patients is essential. The latter involves both characterization of the mechanism and severity of valvular disease as well as determining the hemodynamic consequences and extent of ventricular remodeling, which is an important predictor of future outcomes. Moreover, an assessment of the suitability and risk of complications associated with device-specific therapies is also an important component of the preprocedural evaluation in this cohort. Although echocardiography including 2-dimensional and 3-dimensional methods has an important role in the initial assessment and procedural guidance, cross-sectional imaging, including both computed tomographic imagning and cardiac magnetic resonance imaging, is increasingly being integrated into the evaluation of mitral and tricuspid valve disease. In this review, we discuss the role of cross-sectional imaging in mitral and tricuspid valve disease, primarily valvular regurgitation assessment, with an emphasis on the preprocedural evaluation and implications for transcatheter interventions.
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Affiliation(s)
- Christopher Naoum
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Philipp Blanke
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - João L. Cavalcante
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
| | - Jonathon Leipsic
- From the Department of Cardiology, Concord Hospital, University of Sydney, Australia (C.N.); Department of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul’s Hospital, University of British Columbia, Vancouver, Canada (P.B., J.L.); and Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, PA (J.L.C.)
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12
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Pierce EL, Rabbah JPM, Thiele K, Wei Q, Vidakovic B, Jensen MO, Hung J, Yoganathan AP. Three-Dimensional Field Optimization Method: Gold-Standard Validation of a Novel Color Doppler Method for Quantifying Mitral Regurgitation. J Am Soc Echocardiogr 2016; 29:917-925. [PMID: 27354250 DOI: 10.1016/j.echo.2016.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Accurate diagnosis of mitral regurgitation (MR) severity is central to proper treatment. Although numerous approaches exist, an accurate, gold-standard clinical technique remains elusive. The authors previously reported on the initial development and demonstration of the automated three-dimensional (3D) field optimization method (FOM) algorithm, which exploits 3D color Doppler ultrasound imaging and builds on existing MR quantification techniques. The aim of the present study was to extensively validate 3D FOM in terms of accuracy, ease of use, and repeatability. METHODS Three-dimensional FOM was applied to five explanted ovine mitral valves in a left heart simulator, which were systematically perturbed to yield a total of 29 unique regurgitant geometries. Three-dimensional FOM was compared with a gold-standard flow probe, as well as the most clinically prevalent MR volume quantification technique, the two-dimensional (2D) proximal isovelocity surface area (PISA) method. RESULTS Overall, 3D FOM overestimated and 2D PISA underestimated MR volume, but 3D FOM error had smaller magnitude (5.2 ± 9.9 mL) than 2D PISA error (-6.9 ± 7.7 mL). Two-dimensional PISA remained superior in diagnosis for round orifices and especially mild MR, as predicted by ultrasound physics theory. For slit-type orifices and severe MR, 3D FOM showed significant improvement over 2D PISA. Three-dimensional FOM processing was technically simpler and significantly faster than 2D PISA and required fewer ultrasound acquisitions. Three-dimensional FOM did not show significant interuser variability, whereas 2D PISA did. CONCLUSIONS Three-dimensional FOM may provide increased clinical value compared with 2D PISA because of increased accuracy in the case of complex or severe regurgitant orifices as well as its greater repeatability and simpler work flow.
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Affiliation(s)
- Eric L Pierce
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Jean Pierre M Rabbah
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | | | - Qifeng Wei
- Philips Health Tech, Andover, Massachusetts
| | - Brani Vidakovic
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Morten O Jensen
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Judy Hung
- Echocardiography Laboratory of the Massachusetts General Hospital, Boston, Massachusetts
| | - Ajit P Yoganathan
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia.
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13
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Assessment of Mitral Valve Disease: A Review of Imaging Modalities. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:390. [DOI: 10.1007/s11936-015-0390-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Rahimtoola SH. The year in valvular heart disease. J Am Coll Cardiol 2013; 61:1290-1301. [PMID: 23500330 DOI: 10.1016/j.jacc.2012.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/28/2012] [Accepted: 12/04/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Shahbudin H Rahimtoola
- Griffith Center, Division of Cardiovascular Medicine, Department of Medicine, LAC+USC Medical Center, Keck School of Medicine at University of Southern California, Los Angeles, CA 90033, USA.
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Thavendiranathan P, Liu S, Datta S, Rajagopalan S, Ryan T, Igo SR, Jackson MS, Little SH, De Michelis N, Vannan MA. Quantification of Chronic Functional Mitral Regurgitation by Automated 3-Dimensional Peak and Integrated Proximal Isovelocity Surface Area and Stroke Volume Techniques Using Real-Time 3-Dimensional Volume Color Doppler Echocardiography. Circ Cardiovasc Imaging 2013; 6:125-33. [DOI: 10.1161/circimaging.112.980383] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The aim of this study was to test the accuracy of an automated 3-dimensional (3D) proximal isovelocity surface area (PISA) (in vitro and patients) and stroke volume technique (patients) to assess mitral regurgitation (MR) severity using real-time volume color flow Doppler transthoracic echocardiography.
Methods and Results—
Using an in vitro model of MR, the effective regurgitant orifice area and regurgitant volume (RVol) were measured by the PISA technique using 2-dimensional (2D) and 3D (automated true 3D PISA) transthoracic echocardiography. The mean anatomic regurgitant orifice area (0.35±0.10 cm
2
) was underestimated to a greater degree by the 2D (0.12±0.05 cm
2
) than the 3D method (0.25±0.10 cm
2
;
P
<0.001 for both). Compared with the flowmeter (40±14 mL), the RVol by 2D PISA (20±19 mL) was underestimated (
P
<0.001), but the 3D peak (43±16 mL) and integrated PISA-based (38±14 mL) RVol were comparable (
P
>0.05 for both). In patients (n=30, functional MR), 3D effective regurgitant orifice area correlated well with cardiac magnetic resonance imaging RVol
r
=0.84 and regurgitant fraction
r
=0.80. Compared with cardiac magnetic resonance imaging RVol (33±22 mL), the integrated PISA RVol (34±26 mL;
P
=0.42) was not significantly different; however, the peak PISA RVol was higher (48±27 mL;
P
<0.001). In addition, RVol calculated as the difference in automated mitral and aortic stroke volumes by real-time 3D volume color flow Doppler echocardiography was not significantly different from cardiac magnetic resonance imaging (34±21 versus 33±22 mL;
P
=0.33).
Conclusions—
Automated real-time 3D volume color flow Doppler based 3D PISA is more accurate than the 2D PISA method to quantify MR. In patients with functional MR, the 3D RVol by integrated PISA is more accurate than a peak PISA technique. Automated 3D stroke volume measurement can also be used as an adjunctive method to quantify MR severity.
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Affiliation(s)
- Paaladinesh Thavendiranathan
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Shizhen Liu
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Saurabh Datta
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Sanjay Rajagopalan
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Thomas Ryan
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Stephen R. Igo
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Matthew S. Jackson
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Stephen H. Little
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Nathalie De Michelis
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
| | - Mani A. Vannan
- From the Ohio State University, Columbus, OH (P.T., S.L., S.R., T.R., M.A.V.); Siemens Medical Solutions USA Inc, Mountain View, CA (S.D.); The Methodist DeBakey Heart and Vascular Center, Houston, TX (S.R.I., M.S.J., S.H.L); and University of California Irvine, Orange, CA (N.D.M.)
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Affiliation(s)
- Paul A Grayburn
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX 75226, USA.
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Thavendiranathan P, Phelan D, Thomas JD, Flamm SD, Marwick TH. Quantitative Assessment of Mitral Regurgitation. J Am Coll Cardiol 2012; 60:1470-83. [DOI: 10.1016/j.jacc.2012.05.048] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Revised: 05/07/2012] [Accepted: 05/10/2012] [Indexed: 11/28/2022]
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20
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Grayburn PA. The Importance of Regurgitant Orifice Shape in Mitral Regurgitation. JACC Cardiovasc Imaging 2011; 4:1097-9. [DOI: 10.1016/j.jcmg.2011.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 08/02/2011] [Indexed: 10/16/2022]
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