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Altes A, Levy F, Iacuzio L, Dumortier H, Toledano M, Tartar J, Tribouilloy C, Maréchaux S. Comparison of mitral regurgitant volume assessment between proximal flow convergence and volumetric methods in patients with significant primary mitral regurgitation: an echocardiographic and CMR study. J Am Soc Echocardiogr 2022; 35:671-681. [DOI: 10.1016/j.echo.2022.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022]
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Papolla C, Adda J, Rique A, Habib G, Rieu R. In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method. J Am Soc Echocardiogr 2020; 33:838-847.e1. [DOI: 10.1016/j.echo.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/12/2022]
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Lee K, Om SY, Lee SH, Oh JK, Park HK, Choi YS, Lee SA, Lee S, Kim DH, Song JM, Kang DH, Song JK. Clinical Situations Associated with Inappropriately Large Regurgitant Volumes in the Assessment of Mitral Regurgitation Severity Using the Proximal Flow Convergence Method in Patients with Chordae Rupture. J Am Soc Echocardiogr 2019; 33:64-71. [PMID: 31668504 DOI: 10.1016/j.echo.2019.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Regurgitant volume (RVol) calculated using the proximal flow convergence method (proximal isovelocity surface area [PISA]) has been accepted as a key quantitative parameter for the diagnosis of and clinical decision-making with regard to severe mitral regurgitation (MR). However, a recent prospective study showed a significant overestimation of RVol by the echocardiographic PISA method compared with the MR volume measured using magnetic resonance imaging. We aimed to evaluate the frequency of overestimation of RVol by the PISA method and the clinical conditions that require a different quantitative method to correct the overestimation. METHODS We retrospectively enrolled 166 consecutive patients with degenerative MR and chordae rupture, in whom RVol was measured using both the PISA and two-dimensional Doppler volumetric methods. The volumetric method was used to measure total stroke volume using the two-dimensional Simpson biplane method, and forward stroke volume was measured using pulsed Doppler tracing at the left ventricular (LV) outflow tract. RVol by the volumetric method was calculated using total stroke volume - forward stroke volume. Severe MR was defined as an RVol >60 mL. RESULTS All patients had severe MR based on RVol by the PISA method, but 68 (41.1%) showed RVol by the volumetric method values of <60 mL, resulting in discordant results. The patients with discordant results were characterized by a higher prevalence of female sex, lower body surface area, smaller LV diastolic and systolic dimensions and volumes, smaller left atrial volume, smaller PISA angle, and lower frequency of flail leaflets (39.7% vs 62.2%, P = .004). Multivariate analysis revealed that LV end-diastolic volume (LVEDV) and PISA angle were independent factors, with the best cutoff LVEDV and PISA angle being 173 mL and 103°, respectively. During follow-up (median, 3.4 years; interquartile range, 2.0-4.8 years), mitral valve repair and replacement were performed in 103 and six patients, respectively. The 2-year mitral valve surgery-free survival rate was higher in the discordant group (51.8% ± 0.06% vs 31.2% ± 0.05%, P < .001). CONCLUSIONS Even in the patients with documented chordae rupture, the PISA method alone resulted in inappropriate overestimation of MR severity in a significant proportion of patients. Thus, an additive quantitative method is absolutely necessary in patients with a small LVEDV or narrow PISA angle.
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Affiliation(s)
- Kyusup Lee
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yong Om
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sun Hack Lee
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin Kyung Oh
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hong-Kyung Park
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon-Sil Choi
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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