Impact of a Geometric Correction for Proximal Flow Constraint on the Assessment of Mitral Regurgitation Severity Using the Proximal Flow Convergence Method
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
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 eliminateoverestimation 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 magneticresonance image (CMR) were performed to calculate regurgitant volume (RV). In addition to RV by conventional PISA (RVPISA),convergence angle (α) was measured from 2-dimensional Doppler color flow maps and RV was corrected by multiplying byα/180 (RVAC). RV measured by CMR (RVCMR) was used as a gold standard, which was calculated by the difference between totalstroke volume measured by planimetry of the short axis slices and aortic stroke volume by phase-contrast image. Results: The correlation between RVCMR and RV by echocardiography was modest [RVCMR vs. RVPISA (r = 0.712, p < 0.001)and RVCMR vs. RVAC (r = 0.766, p < 0.001)]. However, RVPISA showed significant overestimation (RVPISA - RVCMR = 50.6 ± 40.6mL vs. RVAC - RVCMR = 7.7 ± 23.4 mL, p < 0.001). The overall accuracy of RVPISA for diagnosis of severe MR, defined as RV ≥ 60mL, was 57.6% (19/33), whereas it increased to 84.8% (28/33) by using RVAC (p = 0.028). Conclusion: Conventional PISA method tends to provide falsely large RV in patients with eccentric MR and a simple geometricAC of the proximal constraint flow largely eliminates overestimation.
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 eliminateoverestimation 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 magneticresonance image (CMR) were performed to calculate regurgitant volume (RV). In addition to RV by conventional PISA (RVPISA),convergence angle (α) was measured from 2-dimensional Doppler color flow maps and RV was corrected by multiplying byα/180 (RVAC). RV measured by CMR (RVCMR) was used as a gold standard, which was calculated by the difference between totalstroke volume measured by planimetry of the short axis slices and aortic stroke volume by phase-contrast image. Results: The correlation between RVCMR and RV by echocardiography was modest [RVCMR vs. RVPISA (r = 0.712, p < 0.001)and RVCMR vs. RVAC (r = 0.766, p < 0.001)]. However, RVPISA showed significant overestimation (RVPISA - RVCMR = 50.6 ± 40.6mL vs. RVAC - RVCMR = 7.7 ± 23.4 mL, p < 0.001). The overall accuracy of RVPISA for diagnosis of severe MR, defined as RV ≥ 60mL, was 57.6% (19/33), whereas it increased to 84.8% (28/33) by using RVAC (p = 0.028). Conclusion: Conventional PISA method tends to provide falsely large RV in patients with eccentric MR and a simple geometricAC of the proximal constraint flow largely eliminates overestimation.
참고문헌 (26)
- Thavendiranathan P, "Quantitative assessment of mitral regurgitation: how best to do it", JACC Cardiovasc Imaging, 5, pp.1161~1175 (2012)[DOI]
- Lancellotti P, "European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease)", Eur J Echocardiogr, 11, pp.307~332 (2010)[DOI]
- Vahanian A, "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, 42, pp.S1~S44 (2012)[DOI]
- Nishimura RA, "2014 AHA", ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology, Circulation, pp.2014, 129[DOI]
- Moraldo M, "Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study", Int J Cardiol, 168, pp.1220~1228 (2013)[DOI]
- Bellenger NG, "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, 21, pp.1387~1396 (2000)[DOI]
- Biner S, "Reproducibility of proximal isovelocity surface area, vena contracta, and regurgitant jet area for assessment of mitral regurgitation severity", JACC Cardiovasc Imaging, 3, pp.235~243 (2010)[DOI]
- Uretsky S, "Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: a prospective multicenter trial", J Am Coll Cardiol, 65, pp.1078~1088 (2015)[DOI]
- Pu M, "Quantification of mitral regurgitation by the proximal convergence method using transesophageal echocardiography. Clinical validation of a geometric correction for proximal flow constraint", Circulation, 92, pp.2169~2177 (1995)[DOI]
- Zoghbi WA, "Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography", J Am Soc Echocardiogr, 16, pp.777~802 (2003)[DOI]
- Chen C, "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, 21, pp.374~383 (1993)[DOI]
- Enriquez-Sarano M, "Changes in effective regurgitant orifice throughout systole in patients with mitral valve prolapse. A clinical study using the proximal isovelocity surface area method", Circulation, 92, pp.2951~2958 (1995)[DOI]
- Gelfand EV, "Severity of mitral and aortic regurgitation as assessed by cardiovascular magnetic resonance: optimizing correlation with Doppler echocardiography", J Cardiovasc Magn Reson, 8, pp.503~507 (2006)[DOI]
- Kizilbash AM, "Comparison of quantitative Doppler with magnetic resonance imaging for assessment of the severity of mitral regurgitation", Am J Cardiol, 81, pp.792~795 (1998)[DOI]
- Cawley PJ, "Prospective comparison of valve regurgitation quantitation by cardiac magnetic resonance imaging and transthoracic echocardiography", Circ Cardiovasc Imaging, 6, pp.48~57 (2013)[DOI]
- Uretsky S, "Quantification of left ventricular remodeling in response to isolated aortic or mitral regurgitation", J Cardiovasc Magn Reson, 12, pp.32~ (2010)[DOI]
- Acker MA, "Mitral-valve repair versus replacement for severe ischemic mitral regurgitation", N Engl J Med, 370, pp.23~32 (2014)[DOI]
- Myerson SG, "Determination of clinical outcome in mitral regurgitation with cardiovascular magnetic resonance quantification", Circulation, 133, pp.2287~2296 (2016)[DOI]
- 손장원, "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", Journal of Cardiovascular Imaging, 21(2), pp.81~89 (2013), 한국심초음파학회[DOI]
- Thavendiranathan P, "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, 25, pp.56~65 (2012)[DOI]
- Choi J, "Differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation according to the severity and characteristics", Circ Cardiovasc Imaging, 7, pp.535~544 (2014)[DOI]
- Heo R, "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, 30, pp.393~403 (2017)[DOI]
- Thavendiranathan P, "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, 6, pp.125~133 (2013)[DOI]
- Buck T, "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, 8, pp.38~ (2015)[DOI]
- Hamada S, "Comparison of accuracy of mitral valve regurgitation volume determined by three-dimensional transesophageal echocardiography versus cardiac magnetic resonance imaging", Am J Cardiol, 110, pp.1015~1020 (2012)[DOI]
- Thomas L, "The mitral regurgitation index: an echocardiographic guide to severity", J Am Coll Cardiol, 33, pp.2016~2022 (1999)[DOI]