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Differential Effect of 3-Dimensional Color Doppler Echocardiography for the Quantification of Mitral Regurgitation According to the Severity and Characteristics

 Jaehuk Choi  ;  Ran Heo  ;  Geu-Ru Hong  ;  Hyuk-Jae Chang  ;  Ji Min Sung  ;  Sang Hoon Shin  ;  In Jeong Cho  ;  Chi-Young Shim  ;  Namsik Chung 
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Blood Flow Velocity ; Echocardiography, Doppler, Color/methods* ; Echocardiography, Three-Dimensional/methods* ; Feasibility Studies ; Female ; Humans ; Image Interpretation, Computer-Assisted/methods ; Male ; Middle Aged ; Mitral Valve/diagnostic imaging ; Mitral Valve/physiopathology ; Mitral Valve Insufficiency/diagnostic imaging* ; Mitral Valve Insufficiency/physiopathology ; Odds Ratio ; Reproducibility of Results ; Severity of Illness Index
echocardiography ; mitral valve insufficiency
BACKGROUND: The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography-based MR quantification has well-documented limitations. METHODS AND RESULTS: We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-color Doppler echocardiography in 211 (95.5%) patients. The quantitative differences between the MR volumes obtained by 2D- and 3D-proximal isovelocity surface area (PISA) were analyzed in various MR subgroups. In the validation cohort (n=52), MR volume obtained by 3D-PISA showed a better agreement with phase-contrast cardiac MRI than 2D-PISA (r=0.97 versus 0.84). In all 211 patients, 2D-PISA underestimated the MR volume when compared with 3D-PISA (52.4±19.6 versus 59.5±25.6 mL; P=0.005). A total of 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having nonsevere MR. In the subgroup analysis, the MR severity (odds ratio, 6.96; 95% confidence interval, 3.04-15.94; P<0.001) and having an asymmetrical orifice (odds ratio, 11.48; 95% confidence interval, 3.72-35.4; P<0.001), and an eccentric jet (odds ratio, 3.82; 95% confidence interval, 1.27-11.48; P=0.017) were predictors of significant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods. CONCLUSIONS: Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetrical orifice. This article demonstrates that 3D-color Doppler echocardiography could be used as a valuable tool to confirm treatment strategy in patients with significant MR.
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5. Research Institutes (연구소) > Yonsei Cardiovascular Research Institute (심혈관연구소) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Sung, Ji Min(성지민)
Shin, Sang Hoon(신상훈)
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Chung, Nam Sik(정남식)
Cho, In Jeong(조인정)
Choi, Jae Huk(최재혁)
Heo, Ran(허란)
Hong, Geu Ru(홍그루) ORCID logo https://orcid.org/0000-0003-4981-3304
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