Validation of Semiautomated Quantification of Mitral Valve Regurgitation by Three-Dimensional Color Doppler Transesophageal Echocardiography

Sebastian Militaru; Odile Bonnefous; Karima Hami; Hélène Langet; Laura Houard; Stéphane Allaire; Anne-Catherine Pouleur; Scott Dianis; Alexandre This; Christophe Beauloye; David Vancraeynest; Agnès Pasquet; Jean-Louis Vanoverschelde; Bernhard L Gerber

doi:10.1016/j.echo.2019.10.013

Validation of Semiautomated Quantification of Mitral Valve Regurgitation by Three-Dimensional Color Doppler Transesophageal Echocardiography

J Am Soc Echocardiogr. 2020 Mar;33(3):342-354. doi: 10.1016/j.echo.2019.10.013.

Affiliations

¹ Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
² Philips Research, Medical Imaging (Medisys), Suresnes, France.
³ Philips Clinical Research Board, Suresnes, France.
⁴ Philips Ultrasound, Andover, Massachusetts.
⁵ Philips Research, Medical Imaging (Medisys), Suresnes, France; INRIA Paris and Sorbonne University, UPMC Univ Paris 6, UMR 7598, Paris, France.
⁶ Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium. Electronic address: bernhard.gerber@uclouvain.be.

PMID: 32143780
DOI: 10.1016/j.echo.2019.10.013

Abstract

Background: The aim of this study was to evaluate the accuracy of mitral regurgitation (MR) volume quantified on three-dimensional (3D) color Doppler transesophageal echocardiography (TEE) using new semiautomated software compared with conventional two-dimensional (2D) proximal isovelocity surface area (PISA) transthoracic echocardiography (TTE) and TEE and cardiac magnetic resonance imaging (CMR).

Methods: Fifty-one patients (mean age, 63 ± 16 years; 35 men) prospectively underwent TTE, TEE, and CMR for MR evaluation. Regurgitant volume (RVol) by 3D MR flow quantification was compared with 2D TTE, TEE, and CMR, and the accuracy of evaluation of severe MR by 3D MR flow quantification was compared against guideline criteria by TEE.

Results: Twenty-nine patients had severe MR, 16 had moderate MR, and six had mild MR. Three-dimensional MR flow quantification was feasible in all patients, including prolapse (n = 37), restriction (n = 9), functional MR (n = 5), and eccentric or multiple jects (n = 41). RVol on 3D MR flow quantification correlated well with RVol on 2D PISA TTE (interclass correlation coefficient [ICC] = 0.75, P < .001), quantitatively estimated RVol (ICC = 0.74, P < .001), and 2D PISA TEE (ICC = 0.79, P < .001). Three-dimensional MR flow quantification agreed better with CMR (ICC = 0.86, P < .001) than did RVol on 2D PISA TTE (ICC = 0.66, P < .001) and 2D PISA TEE (ICC = 0.69, P < .001), with narrower limits of agreement on Bland-Altman analysis. Three-dimensional MR flow quantification had high accuracy for diagnosing severe MR using TEE (area under the curve = 0.85, 95% CI 0.74-0.96, P < .001) or CMR (area under the curve = 0.95; 95% CI, 0.89-1.00; P < .001) as the criterion.

Conclusions: The new software enabled semiautomated 3D MR flow quantification in complex MR with multiple and eccentric jets and showed better agreement with CMR than 2D PISA TTE or TEE, suggesting that this method is more accurate than conventional 2D PISA TTE and TEE.

Keywords: Magnetic resonance imaging; Mitral valve regurgitation; PISA; TEE; Three-dimensional.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Echocardiography, Doppler, Color
Echocardiography, Three-Dimensional*
Echocardiography, Transesophageal
Humans
Male
Middle Aged
Mitral Valve Insufficiency* / diagnostic imaging
Reproducibility of Results
Severity of Illness Index