Journal of Cardiovascular Imaging

Korean Society of Echocardiography (한국심초음파학회)
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Impact of a Geometric Correction for Proximal Flow Constraint on the Assessment of Mitral Regurgitation Severity Using the Proximal Flow Convergence Method

  • Jang, Jeong Yoon (Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital) ;
  • Kang, Joon-Won (Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine) ;
  • Yang, Dong Hyun (Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine) ;
  • Lee, Sahmin (Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine) ;
  • Sun, Byung Joo (Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital) ;
  • Kim, Dae-Hee (Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine) ;
  • Song, Jong-Min (Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine) ;
  • Kang, Duk-Hyun (Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine) ;
  • Song, Jae-Kwan (Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine)
  • Received : 2018.01.16
  • Accepted : 2018.02.26
  • Published : 2018.03.27
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Abstract

Background: Overestimation of the severity of mitral regurgitation (MR) by the proximal isovelocity surface area (PISA) method has been reported. We sought to test whether angle correction (AC) of the constrained flow field is helpful to eliminate overestimation in patients with eccentric MR. Methods: In a total of 33 patients with MR due to prolapse or flail mitral valve, both echocardiography and cardiac magnetic resonance image (CMR) were performed to calculate regurgitant volume (RV). In addition to RV by conventional PISA ($RV_{PISA}$), convergence angle (${\alpha}$) was measured from 2-dimensional Doppler color flow maps and RV was corrected by multiplying by ${\alpha}/180$ ($RV_{AC}$). RV measured by CMR ($RV_{CMR}$) was used as a gold standard, which was calculated by the difference between total stroke volume measured by planimetry of the short axis slices and aortic stroke volume by phase-contrast image. Results: The correlation between $RV_{CMR}$ and RV by echocardiography was modest [$RV_{CMR}$ vs. $RV_{PISA}$ (r = 0.712, p < 0.001) and $RV_{CMR}$ vs. $RV_{AC}$ (r = 0.766, p < 0.001)]. However, $RV_{PISA}$ showed significant overestimation ($RV_{PISA}-RV_{CMR}=50.6{\pm}40.6mL$ vs. $RV_{AC}-RV_{CMR}=7.7{\pm}23.4mL$, p < 0.001). The overall accuracy of $RV_{PISA}$ for diagnosis of severe MR, defined as $RV{\geq}60mL$, was 57.6% (19/33), whereas it increased to 84.8% (28/33) by using $RV_{AC}$ (p = 0.028). Conclusion: Conventional PISA method tends to provide falsely large RV in patients with eccentric MR and a simple geometric AC of the proximal constraint flow largely eliminates overestimation.

Keywords

Acknowledgement

Supported by : Korean Society of Echocardiography

References

  1. Thavendiranathan P, Phelan D, Collier P, Thomas JD, Flamm SD, Marwick TH. Quantitative assessment of mitral regurgitation: how best to do it. JACC Cardiovasc Imaging 2012;5:1161-75. https://doi.org/10.1016/j.jcmg.2012.07.013
  2. Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL; European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010;11:307-32. https://doi.org/10.1093/ejechocard/jeq031
  3. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Lung B, Lancellotti P, Pierard L, Price S, Schafers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the joint task force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012;42:S1-44. https://doi.org/10.1093/ejcts/ezs455
  4. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD; ACC/AHA Task Force Members. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014;129:2440-92. https://doi.org/10.1161/CIR.0000000000000029
  5. Moraldo M, Cecaro F, Shun-Shin M, Pabari PA, Davies JE, Xu XY, Hughes AD, Manisty C, Francis DP. Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study. Int J Cardiol 2013;168:1220-8. https://doi.org/10.1016/j.ijcard.2012.11.059
  6. Bellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, Pennell DJ. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J 2000;21:1387-96. https://doi.org/10.1053/euhj.2000.2011
  7. Biner S, Rafique A, Rafii F, Tolstrup K, Noorani O, Shiota T, Gurudevan S, Siegel RJ. Reproducibility of proximal isovelocity surface area, vena contracta, and regurgitant jet area for assessment of mitral regurgitation severity. JACC Cardiovasc Imaging 2010;3:235-43. https://doi.org/10.1016/j.jcmg.2009.09.029
  8. Uretsky S, Gillam L, Lang R, Chaudhry FA, Argulian E, Supariwala A, Gurram S, Jain K, Subero M, Jang JJ, Cohen R, Wolff SD. Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial. J Am Coll Cardiol 2015;65:1078-88. https://doi.org/10.1016/j.jacc.2014.12.047
  9. Pu M, Vandervoort PM, Griffin BP, Leung DY, Stewart WJ, Cosgrove DM 3rd, Thomas JD. Quantification of mitral regurgitation by the proximal convergence method using transesophageal echocardiography. Clinical validation of a geometric correction for proximal flow constraint. Circulation 1995;92:2169-77. https://doi.org/10.1161/01.CIR.92.8.2169
  10. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ; American Society of Echocardiography. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003;16:777-802. https://doi.org/10.1016/S0894-7317(03)00335-3
  11. Chen C, Koschyk D, Brockhoff C, Heik S, Hamm C, Bleifeld W, Kupper W. Noninvasive estimation of regurgitant flow rate and volume in patients with mitral regurgitation by Doppler color mapping of accelerating flow field. J Am Coll Cardiol 1993;21:374-83. https://doi.org/10.1016/0735-1097(93)90678-T
  12. Enriquez-Sarano M, Sinak LJ, Tajik AJ, Bailey KR, Seward JB. Changes in effective regurgitant orifice throughout systole in patients with mitral valve prolapse. A clinical study using the proximal isovelocity surface area method. Circulation 1995;92:2951-8. https://doi.org/10.1161/01.CIR.92.10.2951
  13. Gelfand EV, Hughes S, Hauser TH, Yeon SB, Goepfert L, Kissinger KV, Rofsky NM, Manning WJ. Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography. J Cardiovasc Magn Reson 2006;8:503-7. https://doi.org/10.1080/10976640600604856
  14. Kizilbash AM, Hundley WG, Willett DL, Franco F, Peshock RM, Grayburn PA. Comparison of quantitative Doppler with magnetic resonance imaging for assessment of the severity of mitral regurgitation. Am J Cardiol 1998;81:792-5. https://doi.org/10.1016/S0002-9149(97)01024-2
  15. Cawley PJ, Hamilton-Craig C, Owens DS, Krieger EV, Strugnell WE, Mitsumori L, D'Jang CL, Schwaegler RG, Nguyen KQ, Nguyen B, Maki JH, Otto CM. Prospective comparison of valve regurgitation quantitation by cardiac magnetic resonance imaging and transthoracic echocardiography. Circ Cardiovasc Imaging 2013;6:48-57. https://doi.org/10.1161/CIRCIMAGING.112.975623
  16. Uretsky S, Supariwala A, Nidadovolu P, Khokhar SS, Comeau C, Shubayev O, Campanile F, Wolff SD. Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation. J Cardiovasc Magn Reson 2010;12:32. https://doi.org/10.1186/1532-429X-12-32
  17. Acker MA, Parides MK, Perrault LP, Moskowitz AJ, Gelijns AC, Voisine P, Smith PK, Hung JW, Blackstone EH, Puskas JD, Argenziano M, Gammie JS, Mack M, Ascheim DD, Bagiella E, Moquete EG, Ferguson TB, Horvath KA, Geller NL, Miller MA, Woo YJ, D'Alessandro DA, Ailawadi G, Dagenais F, Gardner TJ, O'Gara PT, Michler RE, Kron IL; CTSN. Mitral-valve repair versus replacement for severe ischemic mitral regurgitation. N Engl J Med 2014;370:23-32. https://doi.org/10.1056/NEJMoa1312808
  18. Myerson SG, d'Arcy J, Christiansen JP, Dobson LE, Mohiaddin R, Francis JM, Prendergast B, Greenwood JP, Karamitsos TD, Neubauer S. Determination of clinical outcome in mitral regurgitation with cardiovascular magnetic resonance quantification. Circulation 2016;133:2287-96. https://doi.org/10.1161/CIRCULATIONAHA.115.017888
  19. Son JW, Chang HJ, Lee JK, Chung HJ, Song RY, Kim YJ, Datta S, Heo R, Shin SH, Cho IJ, Shim CY, Hong GR, Chung N. Automated quantification of mitral regurgitation by three dimensional real time full volume color Doppler transthoracic echocardiography: a validation with cardiac magnetic resonance imaging and comparison with two dimensional quantitative methods. J Cardiovasc Ultrasound 2013;21:81-9. https://doi.org/10.4250/jcu.2013.21.2.81
  20. Thavendiranathan P, Liu S, Datta S, Walls M, Nitinunu A, Van Houten T, Tomson NA, Vidmar L, Georgescu B, Wang Y, Srinivasan S, De Michelis N, Raman SV, Ryan T, Vannan MA. Automated quantification of mitral inflow and aortic outflow stroke volumes by threedimensional real-time volume color-flow Doppler transthoracic echocardiography: comparison with pulsed-wave Doppler and cardiac magnetic resonance imaging. J Am Soc Echocardiogr 2012;25:56-65. https://doi.org/10.1016/j.echo.2011.10.004
  21. Choi J, Heo R, Hong GR, Chang HJ, Sung JM, Shin SH, Cho IJ, Shim CY, Chung N. Differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation according to the severity and characteristics. Circ Cardiovasc Imaging 2014;7:535-44. https://doi.org/10.1161/CIRCIMAGING.113.001457
  22. Heo R, Son JW, O Hartaigh B, Chang HJ, Kim YJ, Datta S, Cho IJ, Shim CY, Hong GR, Ha JW, Chung N. Clinical implications of three-dimensional real-time color Doppler transthoracic echocardiography in quantifying mitral regurgitation: a comparison with conventional two-dimensional methods. J Am Soc Echocardiogr 2017;30:393-403.e7. https://doi.org/10.1016/j.echo.2016.12.010
  23. Thavendiranathan P, Liu S, Datta S, Rajagopalan S, Ryan T, Igo SR, Jackson MS, Little SH, De Michelis N, Vannan MA. Quantification of chronic functional mitral regurgitation by automated 3-dimensional peak and integrated proximal isovelocity surface area and stroke volume techniques using real-time 3-dimensional volume color Doppler echocardiography: in vitro and clinical validation. Circ Cardiovasc Imaging 2013;6:125-33. https://doi.org/10.1161/CIRCIMAGING.112.980383
  24. Buck T, Plicht B. Real-time three-dimensional echocardiographic assessment of severity of mitral regurgitation using proximal isovelocity surface area and vena contracta area method. Lessons we learned and clinical implications. Curr Cardiovasc Imaging Rep 2015;8:38. https://doi.org/10.1007/s12410-015-9356-7
  25. Hamada S, Altiok E, Frick M, Almalla M, Becker M, Marx N, Hoffmann R. Comparison of accuracy of mitral valve regurgitation volume determined by three-dimensional transesophageal echocardiography versus cardiac magnetic resonance imaging. Am J Cardiol 2012;110:1015-20. https://doi.org/10.1016/j.amjcard.2012.05.037
  26. Thomas L, Foster E, Hoffman JI, Schiller NB. The mitral regurgitation index: an echocardiographic guide to severity. J Am Coll Cardiol 1999;33:2016-22. https://doi.org/10.1016/S0735-1097(99)00111-4

피인용 문헌

  1. In Vitro Quantification of Mitral Regurgitation of Complex Geometry by the Modified Proximal Isovelocity Surface Area Method vol.33, pp.7, 2020, https://doi.org/10.1016/j.echo.2020.03.008