Quantification of Functional Mitral Regurgitation by Real-Time 3D Echocardiography. Comparison With 3D Velocity-Encoded Cardiac Magnetic Resonance

Nina Ajmone Marsan, Jos J M Westenberg, Claudia Ypenburg, Victoria Delgado, Rutger J. van Bommel, Stijntje D. Roes, Gaetano Nucifora, Rob J. van der Geest, Albert de Roos, Johan C. Reiber, Martin J. Schalij, Jeroen J. Bax

Research output: Contribution to journalArticle

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Abstract

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.

LanguageEnglish
Pages1245-1252
Number of pages8
JournalJACC: Cardiovascular Imaging
Volume2
Issue number11
DOIs
Publication statusPublished - Nov 2009

Keywords

  • cardiac magnetic resonance
  • functional mitral regurgitation
  • real-time 3-dimensional echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Marsan, Nina Ajmone ; Westenberg, Jos J M ; Ypenburg, Claudia ; Delgado, Victoria ; van Bommel, Rutger J. ; Roes, Stijntje D. ; Nucifora, Gaetano ; van der Geest, Rob J. ; de Roos, Albert ; Reiber, Johan C. ; Schalij, Martin J. ; Bax, Jeroen J. / Quantification of Functional Mitral Regurgitation by Real-Time 3D Echocardiography. Comparison With 3D Velocity-Encoded Cardiac Magnetic Resonance. In: JACC: Cardiovascular Imaging. 2009 ; Vol. 2, No. 11. pp. 1245-1252.
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title = "Quantification of Functional Mitral Regurgitation by Real-Time 3D Echocardiography. Comparison With 3D Velocity-Encoded Cardiac Magnetic Resonance",
abstract = "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.",
keywords = "cardiac magnetic resonance, functional mitral regurgitation, real-time 3-dimensional echocardiography",
author = "Marsan, {Nina Ajmone} and Westenberg, {Jos J M} and Claudia Ypenburg and Victoria Delgado and {van Bommel}, {Rutger J.} and Roes, {Stijntje D.} and Gaetano Nucifora and {van der Geest}, {Rob J.} and {de Roos}, Albert and Reiber, {Johan C.} and Schalij, {Martin J.} and Bax, {Jeroen J.}",
year = "2009",
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Marsan, NA, Westenberg, JJM, Ypenburg, C, Delgado, V, van Bommel, RJ, Roes, SD, Nucifora, G, van der Geest, RJ, de Roos, A, Reiber, JC, Schalij, MJ & Bax, JJ 2009, 'Quantification of Functional Mitral Regurgitation by Real-Time 3D Echocardiography. Comparison With 3D Velocity-Encoded Cardiac Magnetic Resonance', JACC: Cardiovascular Imaging, vol. 2, no. 11, pp. 1245-1252. https://doi.org/10.1016/j.jcmg.2009.07.006

Quantification of Functional Mitral Regurgitation by Real-Time 3D Echocardiography. Comparison With 3D Velocity-Encoded Cardiac Magnetic Resonance. / Marsan, Nina Ajmone; Westenberg, Jos J M; Ypenburg, Claudia; Delgado, Victoria; van Bommel, Rutger J.; Roes, Stijntje D.; Nucifora, Gaetano; van der Geest, Rob J.; de Roos, Albert; Reiber, Johan C.; Schalij, Martin J.; Bax, Jeroen J.

In: JACC: Cardiovascular Imaging, Vol. 2, No. 11, 11.2009, p. 1245-1252.

Research output: Contribution to journalArticle

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.

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

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