Journal of the American Society of Echocardiography
Clinical InvestigationsEchocardiography in Mitral Valve DiseaseA Novel Approach for Semiautomated Three-Dimensional Quantification of Mitral Regurgitant Volume Reflects a More Physiologic Approach to Mitral Regurgitation
Section snippets
Study Design
We conducted a single-center study in which we prospectively enrolled subjects referred to our echocardiography laboratory at the University of Chicago for clinically indicated TEE for evaluation of valvular heart disease between 2018 and 2020. Patients were categorized by etiology of MR (primary or degenerative vs secondary or functional). Inclusion criteria required patients to have acceptable 3D image quality and at least mild MR, with complete integrative 2D measurements for MR estimation
Results
A total of 50 patients were included in this study, with baseline demographics as shown in Table 1. The mean age of subjects was 71 ± 13 years, with a balanced sex distribution (50% women). The mean 3D ejection fraction was mildly reduced (48 ± 16%) and significantly lower in the functional MR group with larger LV volumes (40 ± 13% vs 61 ± 6%, P < .001). Eccentric MR jets were present in 52% of cases. A spectrum of MR severity was represented, with 14% mild, 46% moderate, and 40% severe (using
Discussion
Our results emphasize the role of temporal flow pattern variations in MR that occur in accordance with underlying mechanism and how this variability exerts an associated impact upon physiologic parameters of MR severity. We demonstrate that dynamic MR flow patterns can be reproducibly captured using a novel semiautomated 3D software program that simultaneously quantifies flow-modeled RVol and transmitral dynamic flow curves that are more reflective of jet alterations occurring throughout the
Conclusion
Although the importance of a time-integrated 3D PISA has been introduced, and consideration of dynamic flow changes over time is an important component of MR assessment, this concept has been difficult to incorporate into clinical practice. We demonstrate the feasibility of a 3D semiautomated program for the assessment of MR using color Doppler as the primary data set, which results in the expression of quantitative parameters that capture the dynamic behavior of MR and impart incremental
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Drs Lang and Singh were provided software support by Philips, Netherlands. Dr Su, Dr Bonnefous, Dr Allaire, Dr Rouet, Dr This, and Ms Laghi are employed by Philips.