Quantification of regurgitation in mitral valve prolapse with automated real time echocardiographic 3D proximal isovelocity surface area: multimodality consistency and role of eccentricity index

• Published in: The International Journal of Cardiovascular Imaging 2021-06, Vol.37 (6), p.1947-1959
• Main Authors: Spampinato, Ricardo A., Lindemann, Frank, Jahnke, Cosima, Paetsch, Ingo, Fahr, Florian, Sieg, Franz, von Roeder, Maximilian, Noack, Thilo, Hilbert, Sebastian, Löbe, Susanne, Strotdrees, Elfriede, Hindricks, Gerhard, Borger, Michael A.
• Format: Article
• Language: English
• Subjects: Asymmetry; Automation; Cardiac Imaging; Cardiology; Coefficient of variation; Consistency; Eccentricity; Echocardiography; Echocardiography, Doppler, Color; Echocardiography, Three-Dimensional; Evaluation; Heart valves; Humans; Imaging; Magnetic resonance; Male; Medicine; Medicine & Public Health; Mitral valve; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - etiology; Mitral valve prolapse; Mitral Valve Prolapse - diagnostic imaging; Original Paper; Parameters; Predictive Value of Tests; Radiology; Regurgitation; Reproducibility of Results; Severity of Illness Index; Surface area
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-021-02179-2

Three-dimensional transthoracic echocardiography (3D-TTE) provides a semi-automated proximal isovelocity surface area method (3D-PISA) to obtain quantitative parameters. Data assessing regurgitation severity in mitral valve prolapse (MVP) are scarce, so we assessed the 3D-PISA method compared with 2D-PISA and cardiovascular magnetic resonance (CMR) and the role of an eccentricity index. We evaluated the 3D-PISA method for assessing MR in 54 patients with MVP (57 ± 14 years; 42 men; 12 mild/mild-moderate; 12 moderate-severe; and 30 severe MR). Role of an asymmetric (i.e. eccentricity index ≥ 1.25) flow convergence region (FCR) and inter-modality consistency were then assessed. 3D-PISA derived regurgitant volume (RVol) showed a good correlation with 2D-PISA and CMR derived parameters (r = 0.86 and r = 0.81, respectively). The small mean differences with 2D-PISA derived RVol did not reach statistical significance in overall population (5.7 ± 23 ml, 95% CI − 0.6 to 12; p = 0.08) but differed in those with asymmetric 3D-FCR (n = 21; 2D-PISA: 72 ± 36 ml vs. 3D-PISA: 93 ± 47 ml; p = 0.001). RVol mean values were higher using PISA methods (CMR 57 ± 33 ml; 2D-PISA 73 ± 39 ml; and 3D-PISA 79 ± 45 ml) and an overestimation was observed when CMR was used as reference (2D-PISA vs. CMR: mean difference: 15.8 ml [95% CI 10–22, p