Elsevier

The American Journal of Cardiology

Volume 143, 15 March 2021, Pages 111-117
The American Journal of Cardiology

Diagnostic and Prognostic Value of Several Color Doppler Jet Grading Methods in Patients With Mitral Regurgitation

https://doi.org/10.1016/j.amjcard.2020.12.027Get rights and content

Color Doppler is a widely used ultrasound imaging method for assessing mitral regurgitation (MR) in clinical practice. Nevertheless, color Doppler-based grading of the MR jet has been rarely considered in clinical studies. We investigated the diagnostic and prognostic value of several color Doppler MR jet grading methods and compared them with quantitative grading of MR. The MR color Doppler jet was assessed in 476 MR patients using an ‘integrated’ eyeballing approach by quantifying the color Doppler jet area, jet area/left atrium area and jet length and using quantitative methods. Clinical endpoints were scored as major adverse clinical events, including cardiovascular death, heart failure hospitalization and mitral valve intervention. When assessed by three echocardiographers, there was a moderate inter-observer agreement for eyeballing color Doppler grade of MR (intraclass correlation coefficient 0.69, p < 0.001). The intra-observer agreement was good for all color Doppler approaches. In primary MR, eyeballing color Doppler correlated well with (in)direct measures of MR severity, with a negative predictive value of 91% when using a grade 2 color Doppler as cut-off. In secondary MR, eyeballing color Doppler grade and jet length were predictors of clinical outcome in Cox proportional hazards analysis (p = 0.003), independent of pulmonary pressures, atrial and ventricular volumes. Overall, the integrated eyeballing approach performed better than color Doppler quantification of the MR jet area and length. In conclusion, this study shows that color Doppler grading of the distal MR jet performs well in predicting events in primary and secondary MR, compared to quantitative grading methods.

Section snippets

Methods

Transthoracic echocardiography was performed prospectively at Ghent University Hospital in 476 patients with MR of different etiologies, of whom 254 patients with PMR (136 with mitral valve prolapse and 118 with nonprolapse degenerative MR) and 223 heart failure patients with ejection fraction <50% and SMR. The study was approved by the local Ethics Committee.

We performed an online survey among 50 Belgian cardiologists on the use of all possible echocardiographic approaches for grading MR.

The

Results

The results from the online survey on echocardiographic MR grading show that all cardiologists (100%, n = 50) used “eyeballing” for color Doppler assessment of the MR jet (BEG), whereas only 14% performed additional MR jet area measurement. Notably, 86% of the cardiologists assessed the severity of MR with any color Doppler method, which was much more frequent than the VCW (applied by 36% of cardiologists), PISA-based methods (34%) and quantitative Doppler (8%).

Three echocardiographers with

Discussion

The present study is the first comprehensive comparative analysis of various color Doppler methods and quantitative grading methods in predicting outcome in both PMR and SMR.

Our online survey showed that among cardiologists, color Doppler grading of the MR jet in the LA appears to be the most applied method for grading MR severity in clinical practice. This is in line with the study from Wang et al. who showed that up to 90% of echocardiographers use color Doppler jet assessment for MR grading,

Authors’ Contributions

Victor Kamoen: Conceptualization, Methodology, Formal analysis, Investigation, Writing - Original Draft, Visualization; Simon Calle: Investigation, Writing - Review & Editing; Milad El Haddad: Software, Resources; Tine De Backer: Validation, Writing - Review & Editing; Marc De Buyzere: Validation, Writing - Review & Editing; Frank Timmermans: Conceptualization, Methodology, Investigation, Writing - Original Draft

Acknowledgments

We thank Karen Desmet for her contribution to the study.

Disclosures

The authors have no conflicts of interest to disclose.

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