Clinical InvestigationMitral RegurgitationSpatiotemporal Complexity of Vena Contracta and Mitral Regurgitation Grading Using Three-Dimensional Echocardiographic Analysis
Section snippets
Study Design and Population
We conducted a single-center, cross-sectional, and retrospective study in patients undergoing a transesophageal echocardiography (TEE) study between 2017 and 2020. The study was approved by the Institutional Ethics Review Board of our institution. Out of 226 patients undergoing TEE with 3D color MR acquisitions, 34 (15%) were excluded (6 patients with trace MR and 28 patients with low-quality 3D color acquisitions and/or fewer than 3 systolic frames). A final sample of 192 patients was included
Patient Data
Data from excluded patients are provided in Supplemental Table 2. In the 192 patients included in the main analysis, 1,143 frames were analyzed in triplicate (3,357 frames were analyzed in total), with a median of 6 frames per patient.
Clinical and echocardiographic data are shown in Table 1 for the overall study sample (n = 192) and stratified by type of MR (PMR, n = 100; SMR, n = 92). In SMR patients, coronary artery disease and atrial fibrillation were more frequent. Moderate or severe aortic
Discussion
Color Doppler jet analysis is a fundamental tool for MR quantification.1 In this study, multiframe VCA was quantified using 3D echocardiography to characterize MR vena contracta complexity. In addition to a high prevalence of noncircular VCAs in both PMR and SMR, the timing of measurements was found to be key in 3D quantification according to our results: while single-frame midsystolic (VCAmid) is the closest approximation to multiframe quantifications (VCAmean), peak VCA (VCAmax) may lead to
Conclusions
Multiframe VCA analysis showed a high prevalence of spatiotemporal complexity features in MR color Doppler vena contracta, challenging the assumption of a circular and constant orifice, with important intermethod quantification discrepancies. VCAmid seems the best single-frame approximation to multiframe quantification, whereas peak VCA measurements may lead to potential overestimation of MR severity.
References (33)
- et al.
Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance
J Am Soc Echocardiogr
(2017) - et al.
Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography
J Am Soc Echocardiogr
(2008) - et al.
Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience
JACC Cardiovasc Imaging
(2008) - et al.
Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography
Circ Cardiovasc Imaging
(2011) - et al.
Effect of dynamic flow rate and orifice area on mitral regurgitant stroke volume quantification using the proximal isovelocity surface area method
J Am Coll Cardiol
(2008) - et al.
Comparison of three-dimensional proximal isovelocity surface area to cardiac magnetic resonance imaging for quantifying mitral regurgitation
Am J Cardiol
(2015) - et al.
Direct measurement of multiple vena contracta areas for assessing the severity of mitral regurgitation using 3D TEE
JACC Cardiovasc Imaging
(2012) - et al.
Comparison of orifice area by transthoracic three-dimensional doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation
Am J Cardiol
(2006) - et al.
Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance
JACC Cardiovasc Imaging
(2009) - et al.
Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation
J Am Coll Cardiol
(1999)
Diagnostic value of 3-dimensional vena contracta area for the quantification of residual mitral regurgitation after MitraClip procedure
JACC Cardiovasc Interv
Direct quantification of mitral regurgitant flow volume by real-time three-dimensional echocardiography using dealiasing of color Doppler flow at the vena contracta
J Am Soc Echocardiogr
Validation of semiautomated quantification of mitral valve regurgitation by three-dimensional color Doppler transesophageal echocardiography
J Am Soc Echocardiogr
A novel technique to quantify the instantaneous mitral regurgitant rate
J Cardiovasc Magn Reson
The effect of systolic variation of mitral regurgitation on discordance between noninvasive imaging modalities
JACC Cardiovasc Imaging
Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial
J Am Coll Cardiol
Cited by (4)
Looking to the Future for the Journal of the American Society of Echocardiography
2023, Journal of the American Society of EchocardiographyParameters of the mitral apparatus in patients with ischemic and nonischemic dilated cardiomyopathy
2023, Journal of International Medical ResearchContemporary Echocardiographic Evaluation of Mitral Regurgitation and Guidance for Percutaneous Mitral Valve Repair
2023, Journal of Clinical MedicineQuantification of primary mitral regurgitation by echocardiography: A practical appraisal
2023, Frontiers in Cardiovascular Medicine
Drs. Lozano-Edo and Jover-Pastor contributed equally to this work.
This work was supported by competitive grants from the Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health-Fondo de Investigación Sanitaria (PI18/01626) and the VLC-BIOMED program (VLC-BIOMED PI2020-13) to J.A.
Conflicts of Interest: None.