Comparison of Mitral Regurgitant Volume Assessment between Proximal Flow Convergence and Volumetric Methods in Patients with Significant Primary Mitral Regurgitation: An Echocardiographic and Cardiac Magnetic Resonance Imaging Study

The evolving role of cardiovascular magnetic resonance in the assessment of mitral valve prolapse

“…Applying the echocardiographic CMR cutoff (MRvol ≥ 60 ml for severe MR) would result in 32% (60 patients) of the patients being reclassified from severe (with PISA) to moderate MR with CMR. Interestingly, the overestimation of MRvol with PISA decreases with MR severity and a reverse trend is observed among patients with MAD, higher LVEDvol and large prolapse volume (22,54).…”

“…Several studies have shown consistent discrepancies between echocardiography (PISA method) and CMR in MR severity grading (54)(55)(56), especially for patients with eccentric jets with a higher MRvol by the PISA method (54,55). A recent study on 188 patients with MVP assessed by echocardiography (PISA and volumetric method) and CMR, confirmed a weak correlation between PISA-MRvol and volumetric methods either by CMR or echocardiography (0.29 and 0.30, respectively, p < 0.001) (54). Applying the echocardiographic CMR cutoff (MRvol ≥ 60 ml for severe MR) would result in 32% (60 patients) of the patients being reclassified from severe (with PISA) to moderate MR with CMR.…”

Questions Regarding a Recent Study Comparing Mitral Regurgitant Volume Between Proximal Flow Convergence and Volumetric Methods: The Importance of Sex Differences

“…House and Nelson for their kind and thoughtful comments on our report about the comparison in clinical practice of mitral regurgitant volume (RVol) methods in patients with significant primary mitral regurgitation (MR) because of prolapse. 1 Indeed, previous studies demonstrated that left ventricular (LV) volumes acquired using the two-dimensional (2D) transthoracic echocardiographic (TTE) Simpson biplane method are underestimated compared with those obtained on cardiac magnetic resonance imaging (CMR), because of apical shortening, differences in the delineation of the blood-myocardium interface, and geometric assumptions. The increasing availability of fully automated threedimensional (3D) TTE quantification software provides more precise assessment of LV volumes with values close to those obtained on CMR.…”

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Congratulations to Altes et al 1 on their important publication comparing mitral regurgitant volume by magnetic resonance imaging (MRI) to echocardiography-derived proximal isovelocity surface area and volumetric regurgitant volume (biplane stroke volume -Doppler stroke volume) data. The biplane data correspond very well with the MRI data.

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Letter to the Editor: Rationale for Using Multiple Echo-Doppler Methods to Quantify Mitral Regurgitation

“…I read with interest the article by Altes et al 1 in the July 2022 issue of JASE in which the authors studied 188 patients with moderate-tosevere or severe chronic mitral regurgitation (MR) due to mitral valve prolapse (MVP) and compared cardiac magnetic resonance (CMR) and transthoracic echocardiographic (TTE) volumetric methods to the proximal flow convergence (proximal isovelocity surface area [PISA]) method for determining mitral regurgitant volume. The authors conclude that mitral regurgitant volumes obtained by the PISA method differ markedly from both the TTE and CMR volumetric methods in that the expected proportional relationship between volumetric mitral regurgitant volume and left ventricular (LV) size was not observed with PISA-calculated regurgitant volume, suggesting that the PISA method for calculating mitral regurgitant volume is incorrect.…”