Abstract
BackgroundAlthough 2D-transthoracic echocardiography (TTE) proximal isovelocity surface area (PISA) is the first-line method to quantify mitral regurgitation (MR), recent studies have shown poor agreement with phase contrast velocity mapping by cardiac magnetic resonance (CMR), which is increasingly accepted as an accurate method to assess regurgitant volume (RV). Angle correction for wall constraint when using the PISA method is recommanded in eccentric jets but its added value in the assessment of MR severity has not been compared to CMR-derived data yet.Methods and ResultsA total of 47 patients (78% male, age 58 ± 12 years) with at least moderate degenerative MR who underwent CMR and 2D TTE prior to mitral valve repair were included in this study. Effective regurgitant orifice (ERO) and RV by the PISA method with and without correction for wall constraint angle were calculated from TTE exams and compared to RV obtained from phase contrast velocity mapping CMR. Severe MR (RV ≥ 60ml) was present in 32 patients according to uncorrected PISA, as compared to 17 according to CMR (p= 0,004). Angle correction was needed in 40 patients. Mean RV at CMR was 63 ± 30 ml, compared to 76 ± 32ml at uncorrected PISA (p<0,001) and 59 ± 24 at corrected PISA (p = 0,12). RV by corrected PISA showed stronger correlation with CMR-derived RV compared to uncorrected PISA-derived RV (r2= 0,69 vs 0,58) and reduced overestimation of RV in eccentric jets (fig. 1).Conclusion BackgroundAlthough 2D-transthoracic echocardiography (TTE) proximal isovelocity surface area (PISA) is the first-line method to quantify mitral regurgitation (MR), recent studies have shown poor agreement with phase contrast velocity mapping by cardiac magnetic resonance (CMR), which is increasingly accepted as an accurate method to assess regurgitant volume (RV). Angle correction for wall constraint when using the PISA method is recommanded in eccentric jets but its added value in the assessment of MR severity has not been compared to CMR-derived data yet. Although 2D-transthoracic echocardiography (TTE) proximal isovelocity surface area (PISA) is the first-line method to quantify mitral regurgitation (MR), recent studies have shown poor agreement with phase contrast velocity mapping by cardiac magnetic resonance (CMR), which is increasingly accepted as an accurate method to assess regurgitant volume (RV). Angle correction for wall constraint when using the PISA method is recommanded in eccentric jets but its added value in the assessment of MR severity has not been compared to CMR-derived data yet. Methods and ResultsA total of 47 patients (78% male, age 58 ± 12 years) with at least moderate degenerative MR who underwent CMR and 2D TTE prior to mitral valve repair were included in this study. Effective regurgitant orifice (ERO) and RV by the PISA method with and without correction for wall constraint angle were calculated from TTE exams and compared to RV obtained from phase contrast velocity mapping CMR. Severe MR (RV ≥ 60ml) was present in 32 patients according to uncorrected PISA, as compared to 17 according to CMR (p= 0,004). Angle correction was needed in 40 patients. Mean RV at CMR was 63 ± 30 ml, compared to 76 ± 32ml at uncorrected PISA (p<0,001) and 59 ± 24 at corrected PISA (p = 0,12). RV by corrected PISA showed stronger correlation with CMR-derived RV compared to uncorrected PISA-derived RV (r2= 0,69 vs 0,58) and reduced overestimation of RV in eccentric jets (fig. 1). A total of 47 patients (78% male, age 58 ± 12 years) with at least moderate degenerative MR who underwent CMR and 2D TTE prior to mitral valve repair were included in this study. Effective regurgitant orifice (ERO) and RV by the PISA method with and without correction for wall constraint angle were calculated from TTE exams and compared to RV obtained from phase contrast velocity mapping CMR. Severe MR (RV ≥ 60ml) was present in 32 patients according to uncorrected PISA, as compared to 17 according to CMR (p= 0,004). Angle correction was needed in 40 patients. Mean RV at CMR was 63 ± 30 ml, compared to 76 ± 32ml at uncorrected PISA (p<0,001) and 59 ± 24 at corrected PISA (p = 0,12). RV by corrected PISA showed stronger correlation with CMR-derived RV compared to uncorrected PISA-derived RV (r2= 0,69 vs 0,58) and reduced overestimation of RV in eccentric jets (fig. 1). Conclusion
Published Version
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