1
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Gosling A, Lyvers J, Warner K, Cobey FC. The Value of Dynamic Three-Dimensional Proximal Isovelocity Surface Area: Preventing Unnecessary Mitral Valve Replacement in a High-Risk Patient. J Cardiothorac Vasc Anesth 2018; 33:566-572. [PMID: 29548903 DOI: 10.1053/j.jvca.2018.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Andre Gosling
- Tufts Medical Center, Department of Anesthesiology and Perioperitive Medicine, Boston, MA
| | - Jeffrey Lyvers
- Duke Medical Center, Department of Anesthesiology, Durham, NC
| | - Kenneth Warner
- Tufts Medical Center, Division of Cardiac Surgery, Boston, MA
| | - Frederick C Cobey
- Tufts Medical Center, Department of Anesthesiology and Perioperitive Medicine, Boston, MA.
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2
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Choi J, Heo R, Hong GR, Chang HJ, Sung JM, Shin SH, Cho IJ, Shim CY, Chung N. Differential Effect of 3-Dimensional Color Doppler Echocardiography for the Quantification of Mitral Regurgitation According to the Severity and Characteristics. Circ Cardiovasc Imaging 2014; 7:535-44. [DOI: 10.1161/circimaging.113.001457] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Jaehuk Choi
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - Ran Heo
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - Geu-Ru Hong
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - Hyuk-Jae Chang
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - Ji Min Sung
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - Sang Hoon Shin
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - In Jeong Cho
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - Chi-Young Shim
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
| | - Namsik Chung
- From the Division of Cardiology, Severance Cardiovascular Hospital (J.C., R.H., G.-R.H., H.-J.C., S.H.S., I.J.C., C.-Y.S., N.C.) and Severance Biomedical Science Institute (H.-J.C.), Yonsei University Health System, Seoul, South Korea; and Department of Statistics, Graduate School of Health and Welfare, CHA University, Seongnam, South Korea (J.M.S.)
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3
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de Agustin JA, Viliani D, Vieira C, Islas F, Marcos-Alberca P, Gomez de Diego JJ, Nuñez-Gil IJ, Almeria C, Rodrigo JL, Luaces M, Garcia-Fernandez MA, Macaya C, Perez de Isla L. Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification. J Am Soc Echocardiogr 2013; 26:1063-72. [PMID: 23860094 DOI: 10.1016/j.echo.2013.06.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The two-dimensional (2D) proximal isovelocity surface area (PISA) method has known technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions and has already been validated for mitral regurgitation assessment. The aim of this study was to apply this novel method in patients with chronic tricuspid regurgitation (TR). METHODS Ninety patients with chronic TR were enrolled. EROA and regurgitant volume (Rvol) were assessed using transthoracic 2D and 3D PISA methods. Quantitative Doppler and 3D transthoracic planimetry of EROA were used as reference methods. RESULTS Both EROA and Rvol assessed using the 3D PISA method had better correlations with the reference methods than using conventional 2D PISA, particularly in the assessment of eccentric jets. On the basis of 3D planimetry-derived EROA, 35 patients had severe TR (EROA ≥ 0.4 cm(2)). Among these 35 patients, 25.7% (n = 9) were underestimated as having nonsevere TR (EROA ≤ 0.4 cm(2)) using the 2D PISA method. In contrast, the 3D PISA method had 94.3% agreement (33 of 35) with 3D planimetry in classifying severe TR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.92 and 0.88 respectively. CONCLUSIONS TR quantification using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method.
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Affiliation(s)
- Jose Alberto de Agustin
- Instituto Cardiovascular, Unidad de Imagen Cardiaca, Hospital Universitario San Carlos, Madrid, Spain.
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4
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Yap CH, Thiele K, Wei Q, Santhanakrishnan A, Khiabani R, Cardinale M, Salgo IS, Yoganathan AP. Novel method of measuring valvular regurgitation using three-dimensional nonlinear curve fitting of Doppler signals within the flow convergence zone. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2013; 60:1295-1311. [PMID: 25004499 DOI: 10.1109/tuffc.2013.2704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Mitral valve regurgitation (MR) is among the most prevalent and significant valve problems in the Western world. Echocardiography plays a significant role in the diagnosis of degenerative valve disease. However, a simple and accurate means of quantifying MR has eluded both the technical and clinical ultrasound communities. Perhaps the best clinically accepted method used today is the 2-D proximal isovelocity surface area (PISA) method. In this study, a new quantification method using 3-D color Doppler ultrasound, called the field optimization method (FOM), is described. For each 3-D color flow volume, this method iterates on a simple fluid dynamics model that, when processed by a model of ultrasound physics, attempts to agree with the observed velocities in a least-squares sense. The output of this model is an estimate of the regurgitant flow and the location of its associated orifice. To validate the new method, in vitro experiments were performed using a pulsatile flow loop and different geometric orifices. Measurements from the FOM and from 2-D PISA were compared with measurements made with a calibrated ultrasonic flow probe. Results show that the new method has a higher correlation to the truth data and has lower inter- and intra-observer variability than the 2-D PISA method.
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5
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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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6
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de Agustín JA, Marcos-Alberca P, Fernandez-Golfin C, Gonçalves A, Feltes G, Nuñez-Gil IJ, Almeria C, Rodrigo JL, Perez de Isla L, Macaya C, Zamorano J. Direct Measurement of Proximal Isovelocity Surface Area by Single-Beat Three-Dimensional Color Doppler Echocardiography in Mitral Regurgitation: A Validation Study. J Am Soc Echocardiogr 2012; 25:815-23. [DOI: 10.1016/j.echo.2012.05.021] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Indexed: 11/30/2022]
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7
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Cobey FC, McInnis JA, Gelfand BJ, Rapo MA, D'Ambra MN. A method for automating 3-dimensional proximal isovelocity surface area measurement. J Cardiothorac Vasc Anesth 2012; 26:507-11. [PMID: 22325633 DOI: 10.1053/j.jvca.2011.12.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The proximal isovelocity surface area (PISA) is used for the echocardiographic quantification of effective orifice areas in valvular stenosis and regurgitation. Typically measured in 2 dimensions, the PISA relies on the geometric assumption that the shape of flow convergence is a hemisphere and that the orifice is a single circular point. Neither assumption is true. The objective was to develop a method for automating the measurement of the PISA in 3 dimensions and to illuminate the actual shape of the flow convergence pattern and how it changes over time. DESIGN Retrospective, single-case study. SETTING Major urban hospital. PARTICIPANTS This study was based on a single patient undergoing mitral valve replacement. INTERVENTIONS No additional interventions were performed in the patient. RESULTS The effective orifice areas calculated from the serial hemispheric, hemi-elliptic, and 3-dimensional (3D) PISAs during diastole were compared with the corresponding planimetric anatomic mitral orifice area. The effective orifice areas based on the manual and automated measurements of 3D PISAs more closely approximated the anatomic orifice than the effective orifice areas calculated using hemispheric or hemi-elliptic PISAs. CONCLUSIONS An automated analysis of 3D color Doppler data is feasible and allows a direct and accurate measurement of a 3D PISA, thus avoiding reliance on simplistic geometric assumptions. The dynamic aspect of cardiac orifices also must be considered in orifice analysis.
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Affiliation(s)
- Frederick C Cobey
- Department of Anesthesiology, Perioperative Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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8
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Zeng X, Levine RA, Hua L, Morris EL, Kang Y, Flaherty M, Morgan NV, Hung J. Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography. Circ Cardiovasc Imaging 2011; 4:506-13. [PMID: 21730026 DOI: 10.1161/circimaging.110.961649] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate quantification of mitral regurgitation (MR) is important for patient treatment and prognosis. Three-dimensional echocardiography allows for the direct measure of the regurgitant orifice area (ROA) by 3D-guided planimetry of the vena contracta area (VCA). We aimed to (1) establish 3D VCA ranges and cutoff values for MR grading, using the American Society of Echocardiography-recommended 2D integrative method as a reference, and (2) compare 2D and 3D methods of ROA to establish a common calibration for MR grading. METHODS AND RESULTS Eighty-three patients with at least mild MR underwent 2D and 3D echocardiography. Direct planimetry of VCA was performed by 3D echocardiography. Two-dimensional quantification of MR included 2D ROA by proximal isovelocity surface area (PISA) method, vena contracta width, and ratio of jet area to left atrial area. There were significant differences in 3D VCA among patients with different MR grades. As assessed by receiver operating characteristic analysis, 3D VCA at a best cutoff value of 0.41 cm(2) yielded 97% of sensitivity and 82% of specificity to differentiate moderate from severe MR. There was significant difference between 2D ROA and 3D VCA in patients with functional MR, resulting in an underestimation of ROA by 2D PISA method by 27% as compared with 3D VCA. Multivariable regression analysis showed functional MR as etiology was the only predictor of underestimation of ROA by the 2D PISA method. CONCLUSIONS Three-dimensional VCA provides a single, directly visualized, and reliable measurement of ROA, which classifies MR severity comparable to current clinical practice using the American Society of Echocardiography-recommended 2D integrative method. The 3D VCA method improves accuracy of MR grading compared with the 2D PISA method by eliminating geometric and flow assumptions, allowing for uniform clinical grading cutoffs and ranges that apply regardless of etiology and orifice shape.
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Affiliation(s)
- Xin Zeng
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA 02114, USA
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9
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Shanks M, Siebelink HMJ, Delgado V, van de Veire NRL, Ng ACT, Sieders A, Schuijf JD, Lamb HJ, Ajmone Marsan N, Westenberg JJM, Kroft LJ, de Roos A, Bax JJ. Quantitative assessment of mitral regurgitation: comparison between three-dimensional transesophageal echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging 2010; 3:694-700. [PMID: 20810848 DOI: 10.1161/circimaging.110.947176] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND quantification of mitral regurgitation severity with 2-dimensional (2D) imaging techniques remains challenging. The present study compared the accuracy of 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE for quantification of mitral regurgitation, using MRI as the reference method. METHODS AND RESULTS two-dimensional and 3D TEE and cardiac MRI were performed in 30 patients with mitral regurgitation. Mitral effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were estimated with 2D and 3D TEE. With 3D TEE, EROA was calculated using planimetry of the color Doppler flow from en face views and Rvol was derived by multiplying the EROA by the velocity time integral of the regurgitant jet. Finally, using MRI, mitral Rvol was quantified by subtracting the aortic flow volume from left ventricular stroke volume. Compared with 3D TEE, 2D TEE underestimated the EROA by a mean of 0.13 cm(2). In addition, 2D TEE underestimated the Rvol by 21.6% when compared with 3D TEE and by 21.3% when compared with MRI. In contrast, 3D TEE underestimated the Rvol by only 1.2% when compared with MRI. Finally, one third of the patients in grade 1 and ≥50% of the patients in grade 2 and 3, as assessed with 2D TEE, would have been upgraded to a more severe grade, based on the 3D TEE and MRI measurements. CONCLUSIONS quantification of mitral EROA and Rvol with 3D TEE is feasible and accurate as compared with MRI and results in less underestimation of the Rvol as compared with 2D TEE.
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Affiliation(s)
- Miriam Shanks
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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10
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11
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Fischer GW, Salgo IS, Adams DH. Real-time Three-Dimensional Transesophageal Echocardiography: The Matrix Revolution. J Cardiothorac Vasc Anesth 2008; 22:904-12. [DOI: 10.1053/j.jvca.2008.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Indexed: 11/11/2022]
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12
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Plicht B, Kahlert P, Goldwasser R, Janosi RA, Hunold P, Erbel R, Buck T. Direct Quantification of Mitral Regurgitant Flow Volume by Real-Time Three-Dimensional Echocardiography Using Dealiasing of Color Doppler Flow at the Vena Contracta. J Am Soc Echocardiogr 2008; 21:1337-46. [DOI: 10.1016/j.echo.2008.09.022] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Indexed: 11/16/2022]
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13
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Buchner S, Debl K, Poschenrieder F, Feuerbach S, Riegger GA, Luchner A, Djavidani B. Cardiovascular Magnetic Resonance for Direct Assessment of Anatomic Regurgitant Orifice in Mitral Regurgitation. Circ Cardiovasc Imaging 2008; 1:148-55. [DOI: 10.1161/circimaging.107.753103] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In patients with mitral regurgitation (MR), assessment of the severity of valvular dysfunction is crucial. Recently, regurgitant orifice area has been proposed as the most useful indicator of the severity of MR. The purpose of our study was to determine whether planimetry of the anatomic regurgitant orifice (ARO) in patients with MR is feasible by cardiovascular magnetic resonance (CMR) and correlates with invasive catheterization and echocardiography effective regurgitant orifice [ECHO-ERO] by proximal isovelocity surface area.
Methods and Results—
Planimetry of ARO was performed with a 1.5-T CMR scanner using a breath-hold balanced gradient echo sequence true fast imaging with steady state precession (TrueFISP). CMR planimetry of ARO was possible in 35 of 38 patients and was closely correlated with angiographic grading (
r
=0.84,
P
<0.0001). In patients with MR grade ≥III on catheterization, CMR-ARO (0.60�0.29 cm
2
versus 0.30�0.19 cm
2
,
P
<0.0001) as well as ECHO-ERO (0.49�0.17 cm
2
versus 0.27�0.10 cm
2
) were significantly elevated in comparison with MR grade <III. Further, CMR-ARO was closely correlated to CMR regurgitant fraction and volume (
r
=0.90 and
r
=0.91,
P
<0.0001, respectively) and catheterization regurgitant fraction and volume (
r
=0.86 and 0.83,
P
<0.0001, respectively). The correlation between CMR-ARO and ECHO-ERO was 0.81 (
P
<0.0001) and CMR slightly overestimated ECHO-ERO by 0.06 cm
2
(
P
<0.05). As assessed by receiver operating characteristic analysis, CMR-ARO at a threshold of 0.40 cm
2
detected MR grade ≥III as defined by catheterization, with a sensitivity and specificity of 94% and 94%, respectively.
Conclusion—
CMR planimetry of the anatomic mitral regurgitant lesion in patients with MR is feasible and permits quantification of MR with good agreement with the accepted invasive and noninvasive methods. Direct measurement by CMR is a promising new method for the precise assessment of ARO area and the severity of MR.
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Affiliation(s)
- Stefan Buchner
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Kurt Debl
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Florian Poschenrieder
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Stefan Feuerbach
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Günter A.J. Riegger
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Andreas Luchner
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
| | - Behrus Djavidani
- From the Klinik und Poliklinik für Innere Medizin II (S.B., K.D., G.R., A.L.) and Institut für Röntgendiagnostik (F.P., S.F., B.D.), Klinikum der Universität Regensburg, Regensburg, Germany
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Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography. J Am Soc Echocardiogr 2008; 21:912-21. [PMID: 18385013 DOI: 10.1016/j.echo.2008.02.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vena contracta width (VCW) as an estimate of effective regurgitant orifice area (EROA) is an accepted parameter of mitral regurgitation (MR) severity. However, uncertainty exists in cases in which VCW at the same time appears narrow in 4-chamber (4CH) view and broad in 2-chamber (2CH) view as common in functional MR with noncircular or slit-like regurgitant orifices. We therefore hypothesized that new real-time 3-dimensional color Doppler echocardiography (RT3DE) can be used for direct assessment of the size and shape of vena contracta area (VCA) in an en face view and to determine the potential error of conventional VCW measurement on estimation of EROA. METHODS RT3DE was performed in 57 patients with relevant MR of different etiologies. Manual tracing of VCA in a cross-sectional plane through the vena contracta was compared with VCW in 4CH and 2CH views. As a comparative approach to VCA-3D, EROA was calculated using the hemispheric and hemielliptic proximal isovelocity surface (PISA) area method. RESULTS Direct measurement of VCA-3D was feasible in all patients within 2.6 +/- 0.7 minutes. RT3DE revealed significant asymmetry of VCA in functional compared with organic MR (P < .001). Among all patients, VCW-4CH and VCW-2CH correlated only moderately to VCA-3D (r =.77; r =.80). Mean VCW correlated and agreed best with VCA-3D (r =.90). VCA-3D correlated and agreed well with EROA by hemielliptic PISA (r = .96, mean error: -0.09 +/- 0.14 cm(2)) compared with significant underestimation of hemispheric PISA in noncircular lesions. CONCLUSIONS Direct assessment of VCA using RT3DE revealed significant asymmetry of VCA in functional MR compared with organic MR, resulting in poor estimation of EROA by single VCW measurements.
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Little SH, Igo SR, McCulloch M, Hartley CJ, Nosé Y, Zoghbi WA. Three-dimensional ultrasound imaging model of mitral valve regurgitation: design and evaluation. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:647-654. [PMID: 18255217 PMCID: PMC3348787 DOI: 10.1016/j.ultrasmedbio.2007.08.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Revised: 07/06/2007] [Accepted: 08/27/2007] [Indexed: 05/25/2023]
Abstract
We describe the development of a cardiac flow model and imaging chamber to permit Doppler assessment of complex and dynamic flow events. The model development included the creation of a circulatory loop with variable compliance and resistance; the creation of a secondary regurgitant circuit; and incorporation of an ultrasound imaging chamber to allow two-dimensional (2D) and three-dimensional (3D) Doppler characterization of both simple and complex models of valvular regurgitation. In all, we assessed eight different pulsatile regurgitant volumes through each of four rigid orifices differing in size and shape: 0.15 cm(2) circle, 0.4 cm(2) circle, 0.35 cm(2) slot and 0.4 cm(2) arc. The achieved mean (and range) hemodynamic measures were: peak trans-orifice pressure gradient 117 mm Hg (40 to 245 mm Hg), trans-orifice peak Doppler velocity 560 cm/s (307 to 793 cm/s), Doppler time-velocity integral 237 cm (111 to 362 cm), regurgitant volume 43 mL (11 to 84 mL) and orifice area 0.32 cm(2) (0.15 to 0.4 cm(2)). The model was designed to optimize Doppler signal quality while reflecting anatomic structural relationships and flow events. The 2D color Doppler, 3D color Doppler and continuous wave Doppler quality was excellent whether the data were acquired from the imaging window parallel or perpendicular to the long-axis of flow. This model can be easily adapted to mimic other intracardiac flow pathology or assess future Doppler applications.
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Affiliation(s)
- Stephen H. Little
- The Department of Cardiology, the Methodist Hospital and the Echocardiography Laboratory of The Methodist DeBakey Heart Center, Houston, TX, USA
| | - Stephen R. Igo
- The Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Marti McCulloch
- The Department of Cardiology, the Methodist Hospital and the Echocardiography Laboratory of The Methodist DeBakey Heart Center, Houston, TX, USA
| | - Craig J. Hartley
- The Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Yukihiko Nosé
- The Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - William A. Zoghbi
- The Department of Cardiology, the Methodist Hospital and the Echocardiography Laboratory of The Methodist DeBakey Heart Center, Houston, TX, USA
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16
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Sugeng L, Weinert L, Lang RM. Real-time 3-Dimensional Color Doppler Flow of Mitral and Tricuspid Regurgitation: Feasibility and Initial Quantitative Comparison with 2-Dimensional Methods. J Am Soc Echocardiogr 2007; 20:1050-7. [PMID: 17583474 DOI: 10.1016/j.echo.2007.01.032] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 11/16/2022]
Abstract
BACKGROUND Visualization of valvular regurgitation using 3-dimensional (3D) echocardiography has been attempted but not routinely performed to date because of technical limitations. With the recent development of a fully sampled matrix-array probe, real-time color flow imaging allows display and analysis of regurgitant jets. Accordingly, the aim of this study was 2-fold. We: (1) investigated the feasibility of transthoracic, real-time visualization of 3D color flow jets; and (2) compared conventional 2-dimensional (2D) Doppler/color flow methods of quantitation (ie, 2D jet/left atrial [LA] area, flow convergence, and vena contracta [VC]) to 3D-derived measurements (3D jet/LA volume, flow convergence, and VC). METHOD In all, 56 patients with good acoustic windows and varying degrees of mitral regurgitation (MR) (n = 32) and tricuspid regurgitation (TR) (n = 24) scheduled for a routine echocardiogram were studied. Using a broadband transducer, 2D color Doppler imaging of TR and MR jets was performed to obtain jet/atrial area ratio, effective regurgitant orifice area, and VC measurements. Subsequently, real-time 3D echocardiography imaging of these jets was performed and analyzed offline using software, resulting in jet/atrial volume ratio, effective regurgitant orifice area, and VC (major and minor axes). RESULTS Of the 56 patients recruited into the study, 86% had sufficient data quality for analysis (87.5% in patients with MR and 83% in patients with TR). Both LA and right atrium were adequately visualized in all patients. Manually traced 3D MR and TR volumes had good agreement when compared with proximal isovelocity surface area-derived volumes (r = 0.7, y = 0.4x + 6.4; and r = 0.8, y = 1.1x + 5.1; respectively) with minimal underestimation and overestimation of volumes for MR and TR (8 and 7 mL, respectively), but with relatively wide limits of agreement for MR (28 mL) versus TR (12 mL). When comparing 3D MR jet/LA volume ratios and TR jet/right atrial volume ratios to 2D MR jet/LA area and 2D TR jet/right atrial area ratios, the former were significantly smaller. The 3D minimum and maximum VC diameter for MR were significantly different compared with those measured with 2D (minimum diameter = 0.7 +/- 0.1 cm, P < .01; maximum diameter = 1.1 +/- 0.5 cm, P < .02 vs 2D = 0.8 +/- 0.3 cm). Conversely, the TR VC minimum diameter was similar but maximum diameter measurements were larger in 3D compared with 2D (3D = 1.3 +/- 0.6 cm vs 2D = 0.7 +/- 0.2 cm, P < .001). CONCLUSION Three-dimensional echocardiography of color flow Doppler of MR and TR jets was feasible. Quantitative methods using 3D echocardiography such as MR and TR volumes correlated well with 2D flow convergence methods. TR VC has more of an elliptic shape, whereas MR is more circular or oval when visualized in 3D. Regurgitant/atrial volume ratios provide a new method of assessing the severity of regurgitant lesions; however, 3D volume-derived ratios were comparatively smaller than those measured with 2D echocardiography.
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Affiliation(s)
- Lissa Sugeng
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
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17
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Abstract
Three-dimensional (3D) color Doppler echocardiography is a relatively new noninvasive tool that displays and quantitates regurgitant flow and also enables estimation of cardiac output, stroke volume, pulmonary outflow, and shunt calculations. This article provides an overview of the current methodology of 3D color flow, and its advantages and limitations.
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Affiliation(s)
- Lissa Sugeng
- Section of Cardiology, Department of Medicine, University of Chicago Medical Center, MC 5084, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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18
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Little SH, Igo SR, Pirat B, McCulloch M, Hartley CJ, Nosé Y, Zoghbi WA. In vitro validation of real-time three-dimensional color Doppler echocardiography for direct measurement of proximal isovelocity surface area in mitral regurgitation. Am J Cardiol 2007; 99:1440-7. [PMID: 17493476 PMCID: PMC3348701 DOI: 10.1016/j.amjcard.2006.12.079] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2006] [Revised: 12/21/2006] [Accepted: 12/21/2006] [Indexed: 11/25/2022]
Abstract
The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional-PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flow-meter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional-PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r(2) = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 +/- 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r(2) = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 +/- 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions.
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Affiliation(s)
| | | | - Bahar Pirat
- Methodist DeBakey Heart Center, Houston, Texas
| | | | | | | | - William A. Zoghbi
- Methodist DeBakey Heart Center, Houston, Texas
- Corresponding author: Tel: 713-441-4342; fax: 713-793-1641. (W.A. Zoghbi)
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19
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Yosefy C, Levine RA, Solis J, Vaturi M, Handschumacher MD, Hung J. Proximal Flow Convergence Region as Assessed by Real-time 3-Dimensional Echocardiography: Challenging the Hemispheric Assumption. J Am Soc Echocardiogr 2007; 20:389-96. [PMID: 17400118 DOI: 10.1016/j.echo.2006.09.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Traditionally, a hemispheric assumption for the proximal flow convergence region (PFCR) is used when calculating mitral regurgitant (MR) effective orifice area (EROA). However, 2-dimensional (2D) echocardiography limits evaluation of the complete PFCR contour. Real-time 3-dimensional (3D) echocardiography (RT3D) allows direct assessment of the true PFCR contour. We hypothesized that the PFCR contour is not necessarily hemispheric, but rather hemielliptic, and aimed to apply a hemielliptic calculation, based on the 3D contour of the PFCR for more accurate MR quantification. METHODS In all, 50 patients with MR underwent RT3D to characterize PFCR contour as hemispheric or hemielliptic. MR EROA by RT3D-derived PFCR was calculated using a hemielliptic formula using 3D data. The 2D EROA was computed using standard hemispheric assumption. EROAs calculated from 2D and RT3D data were compared with quantitative Doppler EROA (mitral inflow--aortic outflow/MR time-velocity integral), used as an independent comparison. RESULTS Only 1 of 50 patients (2%) had a hemispheric PFCR contour by RT3D. The remaining had hemielliptic PFCR contours. Compared with Doppler method, 2D echocardiography significantly underestimated EROA (0.34 +/- 0.14 vs 0.48 +/- 0.25 cm(2), P < .001). RT3D EROA was not significantly different from Doppler EROA (0.52 +/- 0.17 vs 0.48 +/- 0.25, P = not significant). Of 33 patients with Doppler EROA greater than 0.3 cm(2) (> or =moderate-severe MR), 45% (15 of 33) were underestimated as having mild to moderate MR by 2D EROA. CONCLUSIONS The true PFCR contour as shown by RT3D is generally not hemispheric but hemielliptic, tracking the orifice contour. Based on this 3D shape, a hemielliptic approach can be used for practical clinical application with improved MR quantification.
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Affiliation(s)
- Chaim Yosefy
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114-2696, USA
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20
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Le Tourneau T, Polge AS, Gautier C, Deklunder G. [Three-dimensional echography: cardiovascular applications]. JOURNAL DE RADIOLOGIE 2006; 87:1993-2004. [PMID: 17211312 DOI: 10.1016/s0221-0363(06)74183-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Real-time three-dimensional echocardiography is currently used in a standard echocardiographic examination. Volume-rendered images better identify and locate anatomic structures and improve our comprehensive approach to various heart diseases. The assessment of mitral valve disease and congenital cardiopathies and the measurement of left ventricular mass, volume, and ejection fraction are the three main applications of three-dimensional echocardiography. Three-dimensional vascular imaging is an emerging and promising application of three-dimensional echography. The near future of three-dimensional echography requires the integration of all modalities of conventional echography in three dimensional probes, a higher image resolution compared to the current situation, as well as the development of real-time three-dimensional probes dedicated to transesophageal cardiac or vascular examination.
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Affiliation(s)
- T Le Tourneau
- Service d'Explorations Fonctionnelles Cardio-vasculaires, Hôpital Cardiologique, CHRU, Boulevard du Pr. J. Leclercq, 59037 Lille Cedex.
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21
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Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M, Inoue K, Fujii K. Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation. Am J Cardiol 2006; 97:1630-7. [PMID: 16728228 DOI: 10.1016/j.amjcard.2005.12.065] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Revised: 12/06/2005] [Accepted: 12/06/2005] [Indexed: 11/29/2022]
Abstract
Effective regurgitant orifice area is a useful index of the severity of mitral regurgitation (MR). The calculation of regurgitant orifice area using the proximal isovelocity surface area (PISA) method has some technical limitations. Three-dimensional reconstruction of the MR jet was performed using the Live 3D system on a Sonos 7500 to measure regurgitant orifice area directly in 109 cases of MR. Regurgitant orifice area was also measured by quantitative 2-dimensional echocardiography and by the PISA method. To analyze the shape of the regurgitant orifice, the ratio of the long axis to the short axis of the orifice (the L/S ratio) was calculated. Regurgitant orifice area on 3-dimensional echocardiography showed an almost identical correlation with that obtained by quantitative echocardiography (r = 0.91, p <0.0001, slope = 0.97) regardless of the L/S ratio. It was also significantly correlated with orifice area obtained using the PISA method (r = 0.93, p <0.0001). However, orifice area on 3-dimensional echocardiography was significantly larger than that obtained using the PISA method in the whole study group and in the 62 cases of MR with L/S ratios >1.5, whereas the correlation was almost identical in cases of MR with L/S ratios < or =1.5. Orifice area obtained using the PISA method also underestimated that obtained by quantitative echocardiography in cases of MR with L/S ratios >1.5. Three-dimensional echocardiography provided robust values independent of the eccentricity of the MR jet or of cardiac rhythm. In conclusion, the direct measurement of the regurgitant orifice area of MR with 3-dimensional Doppler echocardiography could be a promising method to overcome the limitations of the PISA method, especially in cases of MR with elliptic orifice shapes.
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Affiliation(s)
- Katsuomi Iwakura
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
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22
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Xie MX, Wang XF, Cheng TO, Lu Q, Yuan L, Liu X. Real-Time 3-Dimensional Echocardiography: A Review of the Development of the Technology and Its Clinical Application. Prog Cardiovasc Dis 2005; 48:209-25. [PMID: 16271946 DOI: 10.1016/j.pcad.2005.07.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Real-time 3-dimensional echocardiography (RT3DE) is a new imaging technique that can provide accurate, important, and additional information concerning cardiovascular morphology, pathology, and function. This article will review the development of the technology of RT3DE and its clinical application. As the technique continues to evolve, RT3DE is bound to play an increasingly important role in the diagnosis, prognosis, and treatment of patients with various forms of cardiovascular disease.
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Affiliation(s)
- Ming-Xing Xie
- Department of Echocardiography, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Grossmann G, Marx N, Spiess J, Kochs M. Value of the proximal flow convergence method for quantification of the regurgitant volume in mitral regurgitation Influence of the mechanism of regurgitation, the imaging of the flow convergence region, and different calculation modalities. ZEITSCHRIFT FUR KARDIOLOGIE 2004; 93:944-53. [PMID: 15599569 DOI: 10.1007/s00392-004-0151-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 07/13/2004] [Indexed: 05/01/2023]
Abstract
UNLABELLED The purpose of this study was to evaluate whether the underlying mechanism of mitral regurgitation influences the reliability of the proximal flow con- vergence method to assess the regurgitant volume. Furthermore, the mode of imaging the flow convergence region and different correction algorithms for calculation of the regurgitant volume were compared. METHODS Regurgitant volume was assessed in 45 patients (age 61+/-13 years) with organic (n=19) and functional (n=26) mitral regurgitation by the proximal flow convergence method for aliasing velocities between 14 and 64 cm/s using two-dimensional color Doppler imaging. Different correction and calculation algorithms were compared. In addition, regurgitant volume was determined using color Doppler M-mode for an aliasing velocity of 28 cm/s. The quantitative Doppler method was used as reference. RESULTS In organic mitral regurgitation correlation coefficients (mean differences) between the proximal flow convergence method and the reference method were 0.25-0.43/ 0.58-0.67 (46-111 ml/15-17 ml) before/after geometric correction of the regurgitant volume for the aliasing velocities investigated. The correlation coefficient (mean difference) using color Doppler M-mode imaging was 0.68 (85 ml). The corresponding values in functional mitral regurgitation were 0.74-0.88/0.74-0.88 (-5-8 ml/-7-5 ml) for two-dimensional color Doppler and 0.88 (-1 ml) for M-mode imaging. CONCLUSIONS The regurgitant volume was overestimated by the proximal flow convergence method in organic mitral regurgitation irrespective of the application of different correction algorithms or the use of color Doppler M-mode. A sufficiently reliable determination of the regurgitant volume by the proximal flow convergence method was possible in functional mitral regurgitation. In that case a simplified calculation of the regurgitant volume based on the proximal flow convergence method was feasible.
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Affiliation(s)
- G Grossmann
- Abteilung für Kardiologie, Medizinische Klinik der Universität Ulm, Robert-Koch-Strasse 8, 89081 Ulm, Germany.
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