A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice.

Bargiggia, G. S.; Tronconi, L; Sahn, David J.; Recusani, F; Raisaro, A; Servi, Stefano De; Valdes‐Cruz, Lilliam M.; Montemartini, C

doi:10.1161/01.cir.84.4.1481

Cited by 325 publications

(85 citation statements)

References 21 publications

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“…The flow convergence or proximal isovelocity surface area (PISA) method is derived from the principle that as blood approaches a regurgitant orifice, its velocity increases, forming concentric shells of increasing velocity and decreasing surface area. 1,2 This surface area (PISA) can be estimated during 2-dimensional (2D) color Doppler (CD) echocardiography (2D-CD) assuming a hemispheric distribution of velocity vectors proximal to the regurgitant orifice. Under the principle of flow continuity, the severity of valve dysfunction can be quantified using PISA to determine the effective regurgitant orifice area and regurgitant volume.…”

mentioning

confidence: 99%

In Vitro Validation of Real-Time Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Proximal Isovelocity Surface Area in Mitral Regurgitation

Little

Igo

Pirat

et al. 2007

The American Journal of Cardiology

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The 2-dimensional (2D) color Doppler (2D-CD) proximal isovelocity surface area (PISA) method assumes a hemispheric flow convergence zone to estimate transvalvular flow. Recently developed 3-dimensional (3D)-CD can directly visualize PISA shape and surface area without geometric assumptions. To validate a novel method to directly measure PISA using real-time 3D-CD echocardiography, a circulatory loop with an ultrasound imaging chamber was created to model mitral regurgitation (MR). Thirty-two different regurgitant flow conditions were tested using symmetric and asymmetric flow orifices. Three-dimensional-PISA was reconstructed from a hand-held real-time 3D-CD data set. Regurgitant volume was derived using both 2D-CD and 3D-CD PISA methods, and each was compared against a flowmeter standard. The circulatory loop achieved regurgitant volume within the clinical range of MR (11 to 84 ml). Three-dimensional-PISA geometry reflected the 2D geometry of the regurgitant orifice. Correlation between the 2D-PISA method regurgitant volume and actual regurgitant volume was significant (r 2 = 0.47, p <0.001). Mean 2D-PISA regurgitant volume underestimate was 19.1 ± 25 ml (2 SDs). For the 3D-PISA method, correlation with actual regurgitant volume was significant (r 2 = 0.92, p <0.001), with a mean regurgitant volume underestimate of 2.7 ± 10 ml (2 SDs). The 3D-PISA method showed less regurgitant volume underestimation for all orifice shapes and regurgitant volumes tested. In conclusion, in an in vitro model of MR, 3D-CD was used to directly measure PISA without geometric assumption. Compared with conventional 2D-PISA, regurgitant volume was more accurate when derived from 3D-PISA across symmetric and asymmetric orifices within a broad range of hemodynamic flow conditions. Accurate quantitation of regurgitant volume is an ongoing challenge in the assessment of patients with valvular heart disease. The flow convergence or proximal isovelocity surface area (PISA) method is derived from the principle that as blood approaches a regurgitant orifice, its velocity increases, forming concentric shells of increasing velocity and decreasing surface area. 1,2 This surface area (PISA) can be estimated during 2-dimensional (2D) color Doppler (CD) echocardiography (2D-CD) assuming a hemispheric distribution of velocity vectors proximal to the regurgitant orifice. Under the principle of flow continuity, the severity of valve dysfunction can be quantified using PISA to determine the effective regurgitant orifice area and regurgitant volume. 3

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mentioning

confidence: 99%

In Vitro Validation of Real-Time Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Proximal Isovelocity Surface Area in Mitral Regurgitation

Little

Igo

Pirat

et al. 2007

The American Journal of Cardiology

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“…10 The degree of MR was expressed qualitatively as 1+ to 4+ (3+ and 4+ was considered significant MR) and quantitatively as effective regurgitant orifice area (ERO), quantified as feasible, either with proximal isovelocity surface area method or with quantitative Doppler volumetric method. 11,12 Significant mitral regurgitation was defined as ERO > 0.2 cm 2 . In patients with trace mitral regurgitation ERO was considered null.…”

Section: Echocardiographic Evaluationmentioning

confidence: 99%

Asynchronous Movement of Mitral Annulus: An Additional Mechanism of Ischaemic Mitral Regurgitation

Szymański¹,

Klisiewicz²,

Hoffmań³

2007

Clinical Cardiology

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SummaryIn-coordinate mitral annulus movement might participate in the pathogenesis of functional mitral regurgitation. We evaluated a relationship between indices of mitral annulus systolic asynchrony and mitral regurgitation in patients after myocardial infarction in order to determine independent determinants of effective regurgitant orifice (ERO) area in a multivariate regression model.Tissue Doppler echocardiographic studies and quantitative analysis of mitral regurgitation were performed in 40 patients (33 men, 7 women, mean age 60.1 ± 9.2 years) with a history of Q-wave myocardial infarction, with and without significant functional mitral regurgitation.A multivariate regression model showed that mitral annulus movement asynchrony index-difference between the longest and the shortest time from the R wave in the electrocardiogram to the cessation of systolic movement of the four aspects of mitral annulus, is an independent from ejection fraction, sphericity index, tenting, annulus diameter and infarct location, determinant of mitral regurgitation ERO area (r 2 change 0.72, p 0.01). The only other independent predictor of ERO area was mitral annulus diameter (r 2 change 0.79, p 0.01). Other variables were predictors of ERO only in univariate analyses: ejection fraction (r 2 change 0.59, p 0.01), tenting area (r 2 change 0.76, p 0.01) and sphericity index (r 2 change 0.75, p 0.01).In conclusion, mitral annulus asynchrony is an additional mechanism contributing to the development of functional mitral regurgitation. This suggests, that cardiac resynchronization might be considered, either as a first line intervention in patients with mitral regurgitation not considered for mitral surgery or as a supplementary measure, when results of surgery are suboptimal.

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“…The proximal isovelocity surface area in the flow convergence region was imaged for the blood flow velocity of 29/ 27 cm/s during TTE/TEE by the corresponding first aliasing border, obtained by baseline shifting 4 (Fig. 2).…”

Section: Doppler Measurementsmentioning

confidence: 99%

“…Former studies using either TTE or TEE demonstrated comparable results. 4,7,9,10,16 Neither TTE nor TEE was able to differentiate between grades I and II or between grades III and IV mitral regurgitation because of a broad overlap of the measurements. This also agrees with data from the studies mentioned above.…”

Section: Comparison Between Echocardiography and Cardiac Catheterizationmentioning

confidence: 99%

“…1,2 In addition to measuring the spatial distribution of the regurgitant jet within the left atrium, color Doppler imaging of the flow convergence region proximal to the regurgitant orifice has been applied for quantification of mitral regurgitation using transthoracic (TTE) or transesophageal echocardiography (TEE). [3][4][5][6][7][8][9][10] Since TEE is a semi-invasive approach for diagnosis and quantification of mitral regurgitation, a noninvasive method would be preferable in clinical routine. Thus far, no data exist to indicate whether TTE may be comparable with TEE for the detection and quantification of mitral regurgitation using the proximal flow convergence method, and the purpose of this study was to make such a comparison.…”

Section: Introductionmentioning

confidence: 99%

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Quantification of Mitral Regurgitation by the Proximal Flow Convergence Method—Comparison of Transthoracic and Transesophageal Echocardiography

Großmann

Wöhrle

Kochs

et al. 2002

Clinical Cardiology

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SummaryBackground: No data exist to indicate whether transthoracic (TTE) and transesophageal echocardiography (TEE) are of comparable value for the detection and quantification of mitral regurgitation using the proximal flow convergence method.Hypothesis: The study was performed to compare the value of TTE and TEE for the detection and quantification of mitral regurgitation using this method.Methods: The study included 57 patients with and 11 patients without mitral regurgitation. In all patients, the proximal flow convergence region was imaged by transthoracic and transesophageal color Doppler echocardiography, and proximal isovelocity surface area radii were determined. In 19 patients, monoplane TEE and in 49 patients multiplane TEE was performed. Thirty-one patients with mitral regurgitation underwent cardiac catheterization.Results: Both methods had a comparable sensitivity for the detection of mitral regurgitation. Proximal isovelocity surface area radii derived from TTE and TEE agreed moderately (mean difference Ϫ0.5 ± 1.3 mm). TTE and TEE correlated significantly with the angiographic grade (rank correlation coefficients 0.83 and 0.81), and both differentiated mild to moderate from severe mitral regurgitation with an accuracy of 90%. Regurgitant volumes derived from both echocardiographic techniques and cardiac catheterization correlated moderately (correlation coefficients between 0.67 and 0.81).

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A new method for quantitation of mitral regurgitation based on color flow Doppler imaging of flow convergence proximal to regurgitant orifice.

Cited by 325 publications

References 21 publications

In Vitro Validation of Real-Time Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Proximal Isovelocity Surface Area in Mitral Regurgitation

In Vitro Validation of Real-Time Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Proximal Isovelocity Surface Area in Mitral Regurgitation

Asynchronous Movement of Mitral Annulus: An Additional Mechanism of Ischaemic Mitral Regurgitation

Quantification of Mitral Regurgitation by the Proximal Flow Convergence Method—Comparison of Transthoracic and Transesophageal Echocardiography

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