TY - JOUR
T1 - Quantification of Functional Mitral Regurgitation by Real-Time 3D Echocardiography. Comparison With 3D Velocity-Encoded Cardiac Magnetic Resonance
AU - Marsan, Nina Ajmone
AU - Westenberg, Jos J.M.
AU - Ypenburg, Claudia
AU - Delgado, Victoria
AU - van Bommel, Rutger J.
AU - Roes, Stijntje D.
AU - Nucifora, Gaetano
AU - van der Geest, Rob J.
AU - de Roos, Albert
AU - Reiber, Johan C.
AU - Schalij, Martin J.
AU - Bax, Jeroen J.
N1 - Funding Information:
Drs. Ajmone Marsan and Delgado are financially supported by the Research Fellowship of the European Society of Cardiology. Dr. Schalij has received research grants from Biotronik, Medtronic, and Boston Scientific. Dr. Bax has received research grants from Medtronic, Boston Scientific, Bristol-Myers Squibb Medical Imaging, St. Jude Medical, Biotronik, Edwards Lifesciences, and GE Healthcare.
PY - 2009/11
Y1 - 2009/11
N2 - Objectives: The aim of this study was to evaluate feasibility and accuracy of real-time 3-dimensional (3D) echocardiography for quantification of mitral regurgitation (MR), in a head-to-head comparison with velocity-encoded cardiac magnetic resonance (VE-CMR). Background: Accurate grading of MR severity is crucial for appropriate patient management but remains challenging. VE-CMR with 3D three-directional acquisition has been recently proposed as the reference method. Methods: A total of 64 patients with functional MR were included. A VE-CMR acquisition was applied to quantify mitral regurgitant volume (Rvol). Color Doppler 3D echocardiography was applied for direct measurement, in "en face" view, of mitral effective regurgitant orifice area (EROA); Rvol was subsequently calculated as EROA multiplied by the velocity-time integral of the regurgitant jet on the continuous-wave Doppler. To assess the relative potential error of the conventional approach, color Doppler 2-dimensional (2D) echocardiography was performed: vena contracta width was measured in the 4-chamber view and EROA calculated as circular (EROA-4CH); EROA was also calculated as elliptical (EROA-elliptical), measuring vena contracta also in the 2-chamber view. From these 2D measurements of EROA, the Rvols were also calculated. Results: The EROA measured by 3D echocardiography was significantly higher than EROA-4CH (p < 0.001) and EROA-elliptical (p < 0.001), with a significant bias between these measurements (0.10 cm2 and 0.06 cm2, respectively). Rvol measured by 3D echocardiography showed excellent correlation with Rvol measured by CMR (r = 0.94), without a significant difference between these techniques (mean difference = -0.08 ml/beat). Conversely, 2D echocardiographic approach from the 4-chamber view significantly underestimated Rvol (p = 0.006) as compared with CMR (mean difference = 2.9 ml/beat). The 2D elliptical approach demonstrated a better agreement with CMR (mean difference = -1.6 ml/beat, p = 0.04). Conclusions: Quantification of EROA and Rvol of functional MR with 3D echocardiography is feasible and accurate as compared with VE-CMR; the currently recommended 2D echocardiographic approach significantly underestimates both EROA and Rvol.
AB - Objectives: The aim of this study was to evaluate feasibility and accuracy of real-time 3-dimensional (3D) echocardiography for quantification of mitral regurgitation (MR), in a head-to-head comparison with velocity-encoded cardiac magnetic resonance (VE-CMR). Background: Accurate grading of MR severity is crucial for appropriate patient management but remains challenging. VE-CMR with 3D three-directional acquisition has been recently proposed as the reference method. Methods: A total of 64 patients with functional MR were included. A VE-CMR acquisition was applied to quantify mitral regurgitant volume (Rvol). Color Doppler 3D echocardiography was applied for direct measurement, in "en face" view, of mitral effective regurgitant orifice area (EROA); Rvol was subsequently calculated as EROA multiplied by the velocity-time integral of the regurgitant jet on the continuous-wave Doppler. To assess the relative potential error of the conventional approach, color Doppler 2-dimensional (2D) echocardiography was performed: vena contracta width was measured in the 4-chamber view and EROA calculated as circular (EROA-4CH); EROA was also calculated as elliptical (EROA-elliptical), measuring vena contracta also in the 2-chamber view. From these 2D measurements of EROA, the Rvols were also calculated. Results: The EROA measured by 3D echocardiography was significantly higher than EROA-4CH (p < 0.001) and EROA-elliptical (p < 0.001), with a significant bias between these measurements (0.10 cm2 and 0.06 cm2, respectively). Rvol measured by 3D echocardiography showed excellent correlation with Rvol measured by CMR (r = 0.94), without a significant difference between these techniques (mean difference = -0.08 ml/beat). Conversely, 2D echocardiographic approach from the 4-chamber view significantly underestimated Rvol (p = 0.006) as compared with CMR (mean difference = 2.9 ml/beat). The 2D elliptical approach demonstrated a better agreement with CMR (mean difference = -1.6 ml/beat, p = 0.04). Conclusions: Quantification of EROA and Rvol of functional MR with 3D echocardiography is feasible and accurate as compared with VE-CMR; the currently recommended 2D echocardiographic approach significantly underestimates both EROA and Rvol.
KW - cardiac magnetic resonance
KW - functional mitral regurgitation
KW - real-time 3-dimensional echocardiography
UR - http://www.scopus.com/inward/record.url?scp=70350784142&partnerID=8YFLogxK
U2 - 10.1016/j.jcmg.2009.07.006
DO - 10.1016/j.jcmg.2009.07.006
M3 - Article
C2 - 19909927
AN - SCOPUS:70350784142
SN - 1936-878X
VL - 2
SP - 1245
EP - 1252
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 11
ER -