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Usefulness of 3D-PISA as compared to guideline endorsed parameters for mitral regurgitation quantification

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Abstract

This study was intended to evaluate the diagnostic value of three dimensional proximal isovelocity surface area (3D PISA) derived effective regurgitant orifice area (EROA) and the accuracy of automatic 3D PISA detection in a population resembling clinical practice. Quantification of mitral regurgitation (MR) remains challenging and 3D PISA EROA is a novel diagnostic tool with promising results. However its’ usefulness compared to guideline endorsed parameters has not been shown. In 93 consecutive patients examined in routine practice conventional parameters and 3D-datasets for offline 3D PISA evaluation were recorded. EROA was determined from the largest (peak) PISA and also averaged over systole for meanEROA. Results of 3D PISA calculation were compared with a combination of expert grading by two examiners and two scores for MR grading. In receiver operator characteristic-analysis the meanEROA as determined by 3D PISA had the best diagnostic value (AUC = 0.907 CI 0.832–0.983) as compared to peakEROA (AUC 0.840 CI 0.739–0.941), vena contracta width (AUC 0.831 CI 0.745–0.918) and 2D PISA (AUC 0.747 CI 0.644–0.850). A meanEROA of 0.15 cm2 had a sensitivity of 88.2 % and a specificity of 81.4 % for distinguishing severe from non-severe MR. Semiautomatic 3D PISA detection correlated very well with manually corrected values (r = 0.955). Semiautomatic 3D PISA measurement is feasible in a clinical population and has better diagnostic value compared to 2D PISA. Calculation of mean EROA throughout systole further improves diagnostic value compared to conventional parameters.

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Abbreviations

2D:

Two dimensional

3D:

Three dimensional

AR:

Aortic regurgitation

AUC:

Area under the curve

BMI:

Body mass index

bpm:

Heatbeats per minute

CAD:

Coronary artery disease

CKD:

Chronic kidney disease

COPD:

Chronic obstructive pulmonary disease

E/E′:

Early mitral inflow velocity/early mitral annulus velocity

EDV:

Enddiastolic volume

EROA:

Effective regurgitation orifice area

ICC:

Intraclass correlation coefficient

LA:

Left atrium

LVEF:

Eleft ventricular jection fraction

MR:

Mitral regurgitation

NYHA:

New York Heart Association classification

PISA:

Proximal isovelocity surface area

PMR:

Primary mitral regurgitation

ROC:

Receiver operator characteristic

RVol:

Regurgitation volume

SD:

Standard deviation

SMR:

Secondary mitral regurgitation

sPAP:

Systolic pulmonary artery pressure

VC:

Vena contracta width

VCA:

Vena contracta area

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Conflict of interest

No conflicts of interest were declared by the authors.

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Authors and Affiliations

  1. Department of Medicine II, University Medical Center of Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany

    Frank P. Schmidt, Theresa Gniewosz, Alexander Jabs, Thomas Münzel, Ulrich Hink & Ralph-Stephan von Bardeleben

  2. GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, University of Liège Hospital, Liège, Belgium

    Patrizio Lancellotti

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  1. Frank P. Schmidt
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  2. Theresa Gniewosz
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  3. Alexander Jabs
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  7. Ralph-Stephan von Bardeleben
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Correspondence to Frank P. Schmidt.

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Schmidt, F.P., Gniewosz, T., Jabs, A. et al. Usefulness of 3D-PISA as compared to guideline endorsed parameters for mitral regurgitation quantification. Int J Cardiovasc Imaging 30, 1501–1508 (2014). https://doi.org/10.1007/s10554-014-0496-7

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  • DOI: https://doi.org/10.1007/s10554-014-0496-7

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