Comparison of Accuracy of Mitral Valve Regurgitation Volume Determined by Three-Dimensional Transesophageal Echocardiography Versus Cardiac Magnetic Resonance Imaging

• Published in: The American journal of cardiology 2012-10, Vol.110 (7), p.1015-1020
• Main Authors: Hamada, Sandra, MD, Altiok, Ertunc, MD, Frick, Michael, MD, Almalla, Mohammed, MD, Becker, Michael, MD, Marx, Nikolaus, MD, Hoffmann, Rainer, MD
• Format: Article
• Language: English
• Subjects: Accuracy; Aged; Biological and medical sciences; Blood Flow Velocity; Cardiology. Vascular system; Cardiovascular; Cardiovascular system; Echocardiography, Three-Dimensional - methods; Echocardiography, Transesophageal; Endocardial and cardiac valvular diseases; Female; Flow velocity; Follow-Up Studies; Heart; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging, Cine - methods; Male; Medical sciences; Mitral Valve - diagnostic imaging; Mitral Valve - pathology; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - physiopathology; Myocardial Contraction; Reproducibility of Results; Severity of Illness Index; Statistical analysis; Stroke Volume; Studies; Ultrasonic imaging; Ultrasonic investigative techniques
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2012.05.037

Direct planimetry of anatomic regurgitation orifice area (AROA) using 3-dimensional transesophageal echocardiography (TEE) has been described. This study sought to (1) compare mitral valve regurgitant volume (RV) derived by AROA using 3-dimensional TEE with RV obtained by cardiac magnetic resonance (CMR) imaging and (2) determine the impact of AROA and flow velocity changes throughout systole on the dynamic variation in mitral regurgitation. In 43 patients (71 ± 11 years old) with mild to severe mitral regurgitation, 3-dimensional TEE and CMR were performed. Mitral valve RV was determined based on (1) AROA at 5 subintervals of systole and analysis of the regurgitant continuous-wave Doppler signal at equal durations of systole, (2) effective regurgitation orifice area (EROA) using the proximal isovelocity surface area method, (3) CMR with subtraction of aortic outflow volume from left ventricular stroke volume. RV calculated by AROA tended to overestimate RV less than RV calculated by EROA compared to RV by CMR (average bias +20 ml, 95% confidence interval [CI] −41 to +81, vs +13 ml, 95% CI −22 to 47). In patients with RV >30 ml by CMR, overestimation of RV using the AROA method was less than using the EROA method (difference in means +18 ml, 95% CI 4 to 32, p 30 ml as defined by CMR, the AROA method results in less overestimation of RV than the EROA method. Changes in AROA during systole contribute much less to dynamic variation in mitral regurgitation severity than changes in regurgitant flow velocity.