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The mitral to aortic/pulmonary velocity-time integral ratio is a simple, feasible and accurate discriminator for echocardiographic evaluation of severe isolated mitral regurgitation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Echocardiographic quantification of mitral regurgitation (MR) remains challenging, requiring dedicated image acquisition, and is limited by potential error from geometric assumptions of annular dimensions. Volume is a product of area and flow and assuming proportional mitral/aortic areas, an increased mitral-inflow volume compared to LV/RV-outflow semi-quantitatively represents greater MR regurgitant volume. Therefore, we investigated the feasibility and diagnostic performance of the mitral-aortic velocity-time integral (VTI) ratio in isolated MR. We also investigated the use of the mitral-pulmonary VTI ratio as an alternative in clinical situations where the LV outflow tract (LVOT) VTI could not be used.
Methods
We reviewed 166 consecutive patients (54 (33% severe MR by multi-parameter integrated expert opinion)). Pulsed-Doppler VTI at the mitral leaflet tips and the left ventricular outflow and continuous-wave Doppler of the right ventricular outflow tract were measured individually and independently by blinded readers (expert and trainee status) to derive the ratio. Receiver operator characteristic area under the curve (AUC) comparison was calculated and compared with effective regurgitant orifice area (EROA >40 mm), regurgitant volume (RVol >6 0mL), vena contracta (VC >0.7 cm), E-velocity >1.2 cm, systolic flow reversal (SFR), left atrial and ventricular dilatation.
Results
Increasing ratio was associated with severe MR (AUC 0.94) with optimal threshold defined at 1.3. This provided significant discrimination for severe MR (AUC 0.81) compared to EROA (0.68), VC (0.52), LV dilatation (0.69), LA dilatation (0.70), SFR (0.73), E-velocity (0.68) all p<0.05, with sensitivity 82% and specificity 94%. The mitral-pulmonary VTI ratio demonstrated similar discrimination (AUC 0.92) with optimal threshold defined at 1.14. Excellent inter-observer reproducibility (intra-class correlation 0.97) was seen between trainee and expert readers. There was no difference in AUC comparison by MR mechanism or patient rhythm.
Conclusions
The mitral-aortic or mitral-pulmonary VTI ratio is a simple, geometric-free parameter feasibly reproducible from routine echocardiographic datasets and is an excellent discriminative tool for severe MR. Readers should consider integration of this parameter in routine reporting.
Funding Acknowledgement
Type of funding sources: None.
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297 Cardiac MRI Reclassifies Device Therapy Candidates; A Comparative Study With Transthoracic Echocardiogram. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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574 Utility of Non-Invasive Coronary Assessment in Australia According to Age Groups. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Long-Term Outcomes of Patients Undergoing TAVI in Australia. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mediastinal Lymphoma Presenting as a Pericardial Effusion and Systolic Murmur. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Can a Simple Velocity Time Integral Ratio Between the Left Ventricular Outflow Tract and Mitral Inflow Assist in Evaluation of Isolated Aortic Regurgitation? Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bioprosthetic Aortic Valve Leaflet Thrombosis Detected by Multidetector Computed Tomography is Associated With Adverse Cerebrovascular Events: A Meta-Analysis of Observational Studies. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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The Prevalence of Leaflet Thrombosis in Intra-Annular Versus Supra-Annular Transcatheter Aortic Valve Prostheses and the Role of the Neo-Sinus: A Systematic Review. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.1000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Large single-centre outcome of next-generation transcatheter aortic valve replacement (TAVR) systems in low-intermediate surgical risk patients. Intern Med J 2017. [DOI: 10.1111/imj.12_13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Investigating the Impact of Aorto-Ventricular Angulation on Procedural Success in Transcatheter Aortic Valve Replacements with the Lotus Valve System. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Next-Generation Transcatheter Aortic Valve Replacement (TAVR) Clinical Outcomes in Low-Intermediate Risk Patients: Large Single-Centre Experience. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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