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

Abstract

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 < 0.001]; and 3D-PISA vs. CMR: 21.5 ml [95% CI 14–29, p < 0.001]). Intra- and inter-observer reliability was excellent (ICC 0.91–0.99), but with numerically lower coefficient of variation for 3D-PISA (8%–10% vs. 2D-PISA: 12%–16%). 3D-PISA method for assessing regurgitation in MVP may enable analogous evaluation compared to standard 2D-PISA, but with overestimation in case of asymmetric FCR or when CMR is used as reference method.

3D echocardiography in mitral valve prolapse

“…The first consists in measurement of the 3D surface of the proximal flow convergence region without any geometric assumption ( 74 ). Spampinato et al prospectively evaluated the diagnostic accuracy of the 3D PISA method in comparison to standard 2D echocardiography, and cardiac magnetic resonance, using a multiparametric 2D TTE approach as reference for assessing the MR grade in a population of MVP patients ( 80 ). They showed that semi-automated RT 3DE derived PISA may allow similar MR grading as compared to standard 2D TTE, with overestimation in case of asymmetric flow convergence zone or when assuming cardiac magnetic resonance as reference ( 80 ).…”

“…Spampinato et al prospectively evaluated the diagnostic accuracy of the 3D PISA method in comparison to standard 2D echocardiography, and cardiac magnetic resonance, using a multiparametric 2D TTE approach as reference for assessing the MR grade in a population of MVP patients ( 80 ). They showed that semi-automated RT 3DE derived PISA may allow similar MR grading as compared to standard 2D TTE, with overestimation in case of asymmetric flow convergence zone or when assuming cardiac magnetic resonance as reference ( 80 ). The authors argued that 3D PISA has the advantage to display the localization and extension of the proximal flow convergence region from the “en-face” view, aiding the observer in the evaluation of MVP complexity ( 80 ).…”

“…They showed that semi-automated RT 3DE derived PISA may allow similar MR grading as compared to standard 2D TTE, with overestimation in case of asymmetric flow convergence zone or when assuming cardiac magnetic resonance as reference ( 80 ). The authors argued that 3D PISA has the advantage to display the localization and extension of the proximal flow convergence region from the “en-face” view, aiding the observer in the evaluation of MVP complexity ( 80 ). The AROA is a direct measure of the regurgitant orifice, rather than a measure derived from hemodynamic data ( 81 ).…”

Aortic Regurgitation in the Practice of a Internist

“…У данного метода есть ограничения, например из-за того, что регургитационное отверстие может быть не совсем круглым, а следовательно, проксимальная изоскоростная зона получается не совсем идеальной полусферой. Но это преодолимо, например с помощью 3-d эхокардиографии [11]. Для оценки тяжести АР имеет также значение vena contracta, самый узкий участок струи из аорты в выходной тракт левого желудочка.…”