Measurement of mitral valve area in patients with mitral stenosis by 3D echocardiography: A comparison between direct planimetry on 3D zoom and 3D quantification

Sadeghian, Hakimeh; Rezvanfard, Mehrnaz; Jalali, Arash

doi:10.1111/echo.14397

Cited by 6 publications

(6 citation statements)

References 19 publications

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“…Eibel et al [13] demonstrated that the direct delineation in the en-face 3D-TEE mode leads to a non-significant underestimation of MVA compared to MPR measurements in a cohort of patients who predominately had a normal MVA. Sadeghian et al [18] found that MVA MPR overestimated the MVA compared to MVA obtained by direct planimetry on the 3D zoom mode in rheumatic MS patients, which is in agreement with our study. The mean difference found in their study was approximately 0.9 cm 2 .…”

Section: Discussionsupporting

confidence: 93%

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Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?

Zhong

Chen

Shi

et al. 2020

Int J Cardiovasc Imaging

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3D direct planimetry is increasingly used in clinical practice as a rapid way to measure the mitral valve area (MVA) in patients with rheumatic mitral stenosis (MS) who underwent three-dimensional transesophageal echocardiography (3D-TEE). However, data on its accuracy and reliability are scarce. This study aimed to compare the MVA measurements obtained by 3D direct planimetry to the conventional technique multiplanar reconstruction (MPR) in MS patients using 3D-TEE. We retrospectively included 49 patients with rheumatic MS undergoing clinically-indicated 3D-TEE in the study. We determined the 3D direct planimetry measurements of MVA from the left atria aspect (MVA LA ) and the left ventricle aspect (MVA LV ), and compared those with the MPR method (MVA MPR ). We also assessed the major and minor diameters of the mitral valve orifice using MPR and 3D direct planimetry. We found an excellent agreement between the MVA measurements obtained by the MPR method and 3D direct planimetry (MVA LA and MVA LV ) [intraclass correlation coefficients (ICC) = 0.951 and 0.950, respectively]. However, the MVA MPR measurements were significantly larger than the MVA LA and MVA LV (p < 0.001; mean difference: 0.12 ± 0.15 cm 2 and 0.11 ± 0.16 cm 2 , respectively).The inter-observer and intra-observer variability ICC were 0.875 and 0.856 for MVA MPR , 0.982 and 0.984 for MVA LA , and 0.988 and 0.986 for MVA LV , respectively. The major diameter measured by MPR (1.90 ± 0.42 cm) was significantly larger than that obtained by 3D direct planimetry (1.72 ± 0.35 cm for the LA aspect, p < 0.001; 1.73 ± 0.36 cm for the LV aspect, p < 0.001). The minor diameter measured by MPR (0.96 ± 0.25 cm) did not differ from that derived by 3D direct planimetry (0.94 ± 0.25 cm for the LA aspect, p = 0.07; 0.95 ± 0.27 cm for the LV aspect, p = 0.32). 3D direct planimetry provides highly reproducible measurements of MVA and yields data in excellent agreement with those obtained by the MPR method. The discrepancy between the two techniques may be due to differences in major diameter measurements of the mitral valve orifice.

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Section: Discussionsupporting

confidence: 93%

“…Recently, 3D direct planimetry has more frequently been used in clinical practice as a fast way to measure the MVA [15][16][17]. However, research assessing the effectiveness of the 3D direct planimetry method and its comparison to the MPR method is lacking [18].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?

Zhong

Chen

Shi

et al. 2020

Int J Cardiovasc Imaging

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“…In this method, planimetry was applied at en face MV orientation from both left atrial and left ventricular sides. Planimetry at both 3D-direct and 3D-MPR methods was performed on MV lea ets tips in mid diastole during the maximal opening, at the smallest ori ce dimension (11,12,13). All measurements were done with an expert echocardiographist and were subsequently reviewed by a second echocardiographist.…”

Section: D -Teementioning

confidence: 99%

“…We compared the results of these two methods at the valve area below 1 cm 2 , 1-1.5 cm 2 and above 1.5 cm 2 in large numbers of patients with MS to assess the role of mitral valve shape on planimetry. Moreover, we evaluated the association between 2D-TTE and 3D-TEE planimetry results, with a consideration of their moderate to good agreement which is addressed at some previously published studies (13).…”

Section: Introductionmentioning

confidence: 99%

Measurement of mitral valve area by direct three dimensional planimetry compared to multiplanar reconstruction in patients with rheumatic mitral stenosis

Toufan

Azad

Khezerlouy-Aghdam

et al. 2022

Int J Cardiovasc Imaging

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Background: Mitral valve area (MVA) measurement by three-dimensional transesophageal echocardiography (3D-TEE) has a crucial role in the evaluation of mitral stenosis (MS) severity. Threedimensional direct (3D-direct) planimetry has been proposed as a new technique to measure mitral valve area. This study aimed to compare the 3D-direct mitral valve planimetry to conventional threedimensional multiplanar reconstruction (3D-MPR) in severe mitral stenosis (MS) using 3D-TEE.Methods: 149 patients with severe MS who were referred for percutaneous transmitral commissurotomy (PTMC), prospectively recruited. All patients underwent 2D transthoracic echocardiography (2D-TTE) and 3D-TEE in a single session before PTMC. During 2D-TTE planimetry, pressure half time (PHT), and proximal isovelocity surface area (PISA) were applied to measure the MVA. Transmitral mean pressure gradient (MPG) was measured. During 3D-TEE, MVA planimetry was carried out with both 3D-direct and 3D-MPR methods. 3D-direct was applied from both atrial and ventricular views. The consistency of MVA measurements with 3D-direct, 3D-MPR, and 2D-TTE methods was statistically investigated.Results: Our sample consisted of 109 (73.2%) women and 40 (26.8%) men. The mean age was 51.75 ± 9.81 years. The agreement between 3D-direct and 3D-MPR planimetry was signi cant and moderate (0.99 ± 0.29 cm 2 vs. 1.12 ± 0.26 cm 2 , Intraclass Correlation = 0.716, p value =0.001).The accuracy of the 3Ddirect method reduced signi cantly compared to the MPR method at MVA > 1.5 cm 2 . The maximum difference between two methods was observed in cases with MVAs larger than 1.5 cm 2 . MVA measured with the 3D-MPR method was signi cantly correlated with a 2D-TTE method, with a moderate agreement (Intraclass Correlation = 0.644, p value = 0.001). Also, 2D-TTE and 3D-direct TEE techniques yielded signi cantly consistent measurements of the MVA (1.06 ± 0.026 cm 2 vs. 0.99 ± 0.29 cm 2 , Intraclass Correlation = 0.787, p value = 0.001); however, with a slight overestimation of the MVA by the former with a net difference of 0.06 ± 0.013 cm 2 . Mitral valve pressure gradient (MPG) had no signi cant correlation with planimetry results. A signi cant inverse correlation was seen between the MVA and pulmonary arterial systolic pressure.Conclusion: 3D-direct planimetry has an acceptable agreement with 3D-MPR planimetry at MVA less than 1.5 cm 2 , but their correlation decreases signi cantly at MVA above 1.5 cm 2 . 3D-direct planimetry underestimates MVA compared to 3D-MPR, especially at MVA above 1.5 cm 2 . The 2D-TTE planimetry has generally acceptable accuracy, but its correlation to the 3D-TEE methods is signi cantly reduced in cases with moderate to severe MS (i.e. MVA> 1.0cm2).

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“…Mitral valve area (MVA) is technically measured by two-dimensional (2D) planimetry with high precision to assess the severity of mitral pathological changes, such as stenosis (1). However, the improvement of imaging methods using three-dimensional techniques has been considered in some studies to achieve the accurate values of these changes and minimize diagnostic errors (especially in the presence of distorted valvular tip or poor echo widow) (2).…”

Section: Introductionmentioning

confidence: 99%

Impact of Left Atrial Volume Index on Discrepancy in Mitral Valve Area Assessed by Two-Dimensional Planimetry and Three-Dimensional Multi-Planar Reconstruction Technique

Toufan

Jabbary

2021

ircmj

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Background: Mitral valve area (MVA) is technically measured using both two-dimensional (2D) planimetry and three dimensional multi planar reconstruction (3D-MPR) techniques; however, studies have always overestimated MVA using the former method. Objectives: This study aimed to assess the correlation between MVA assessed by 2D and 3D techniques and the impact of left atrial volume index (LAVI) on the discrepancy between MVA assessed by two echocardiography techniques. Methods: The data of 75 patients with moderate to severe mitral stenosis assessed by both 2D planimetry and 3D-MPR techniques were retrospectively reviewed. Clinical and echocardiographic variables were evaluated. Left atrial (LA) volume was determined using biplane area-length method. Results: The mean MVA assessed by the 2D and 3D techniques was 1.03±0.24 cm2 and 0.99±0.25 cm2 with a mean discrepancy of 0.04±0.15 cm2, respectively. A strong association was observed between the MVA values assessed by 2D planimetry and 3D-MPR methods (r coefficient = 0.817, P<0.001) indicating a slight discrepancy between the two techniques in assessing MVA measure. The pointed discrepancy was affected by none of the baseline characteristics and LAVI value. There was an adverse association between LAVI value and MVA measured by both 2D planimetry (r coefficient = -0.291, P= 0.011) and 3D-MPR (r coefficient=-0.260, P=0.024). Conclusion: In contrast to the left atrial dimension, the discrepancy in MVA values assessed by 2D planimetry and 3D-MPR is not influenced by LAVI adjusted for baseline parameters.

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Measurement of mitral valve area in patients with mitral stenosis by 3D echocardiography: A comparison between direct planimetry on 3D zoom and 3D quantification

Cited by 6 publications

References 19 publications

Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?

Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?

Measurement of mitral valve area by direct three dimensional planimetry compared to multiplanar reconstruction in patients with rheumatic mitral stenosis

Impact of Left Atrial Volume Index on Discrepancy in Mitral Valve Area Assessed by Two-Dimensional Planimetry and Three-Dimensional Multi-Planar Reconstruction Technique

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