Direct Measurement of Proximal Isovelocity Surface Area by Single-Beat Three-Dimensional Color Doppler Echocardiography in Mitral Regurgitation: A Validation Study

Agustín, José; Marcos‐Alberca, Pedro; Fernández-Golfín, Covadonga; Gonçalves, Alexandra; Feltes, Gisela; Núñez‐Gil, Iván J.; Almerı́a, Carlos; Rodrigo, José Luis; Isla, Leopoldo Pérez de; Macaya, Carlos; Zamorano, José Luís

doi:10.1016/j.echo.2012.05.021

Cited by 80 publications

(61 citation statements)

References 39 publications

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“…The use of an automated 3D method to quantify the true 3D peak PISA using nongated real-time 3D volume color flow Doppler (RT-VCFD) transthoracic echocardiography in mostly degenerative MR was recently illustrated 12 in comparison with echocardiographic reference standards. However, this method has not been validated in an in vitro model of MR under controlled hemodynamic conditions or tested against an external reference standard, such as cardiac magnetic resonance (CMR) imaging.…”

Section: Clinical Perspective On P 133mentioning

confidence: 99%

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

Thavendiranathan

Liu

Datta

et al. 2013

Circ: Cardiovascular Imaging

125

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Background-The aim of this study was to test the accuracy of an automated 3-dimensional (3D) proximal isovelocity surface area (PISA) (in vitro and patients) and stroke volume technique (patients) to assess mitral regurgitation (MR) severity using real-time volume color flow Doppler transthoracic echocardiography. Methods and Results-Using an in vitro model of MR, the effective regurgitant orifice area and regurgitant volume (RVol) were measured by the PISA technique using 2-dimensional (2D) and 3D (automated true 3D PISA) transthoracic echocardiography. The mean anatomic regurgitant orifice area (0.35±0.10 cm 2 ) was underestimated to a greater degree by the 2D (0.12±0.05 cm 2 ) than the 3D method (0.25±0.10 cm 2 ; P<0.001 for both). Compared with the flowmeter (40±14 mL), the RVol by 2D PISA (20±19 mL) was underestimated (P<0.001), but the 3D peak (43±16 mL) and integrated PISA-based (38±14 mL) RVol were comparable (P>0.05 for both). In patients (n=30, functional MR), 3D effective regurgitant orifice area correlated well with cardiac magnetic resonance imaging RVol r=0.84 and regurgitant fraction r=0.80. Compared with cardiac magnetic resonance imaging RVol (33±22 mL), the integrated PISA RVol (34±26 mL; P=0.42) was not significantly different; however, the peak PISA RVol was higher (48±27 mL; P<0.001). In addition, RVol calculated as the difference in automated mitral and aortic stroke volumes by real-time 3D volume color flow Doppler echocardiography was not significantly different from cardiac magnetic resonance imaging (34±21 versus 33±22 mL; P=0.33). Conclusions-Automated real-time 3D volume color flow Doppler based 3D PISA is more accurate than the 2D PISA method to quantify MR. In patients with functional MR, the 3D RVol by integrated PISA is more accurate than a peak PISA technique. Automated 3D stroke volume measurement can also be used as an adjunctive method to quantify MR severity. (Circ Cardiovasc Imaging. 2013;6:125-133.)Key Words: 3D integrated PISA ◼ 3D peak PISA ◼ automated 3D stroke volume ◼ cardiac MR imaging ◼ mitral regurgitation ◼ real-time 3D volume color flow Doppler echocardiography

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Section: Clinical Perspective On P 133mentioning

confidence: 99%

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

Thavendiranathan

Liu

Datta

et al. 2013

Circ: Cardiovascular Imaging

125

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“…Current treatment guidelines for MR recommend surgery for severe MR (RV, ≥60 mL) with symptoms and overt LV dysfunction, LV enlargement, pulmonary hypertension, or AF. 21 In this study, 24 (33.3%) patients with identified as having severe MR by 3D-PISA were undergraded as having nonsevere MR by 2D-PISA. Considering the importance of quantifying the severity of MR for proper clinical decision making and determining the timing of surgical intervention, 2-5 the 2D-based quantification of severe MR has significant limitations.…”

Section: Comparison Of Mr Quantification By 2d-and 3d-pisa Methodsmentioning

confidence: 99%

“…MR volume by 3D-PISA was calculated as EROA by 3D-PISA multiplied by the MR time-velocity integral. 21 A representative case of quantification of MR by 3D-PISA method is demonstrated in Figures 1C and 2D and 2E.…”

Section: Three-dimensional Color Doppler Echocardiographymentioning

confidence: 99%

“…11 And treatment guidelines for MR recommend surgery for severe MR and recommend medical treatment for nonsevere MR. 21 If severe MR are undergraded as having nonsevere MR by 2D-PISA, it leads to wrong treatment. Thus, we decided the cutoff volume of significant difference between the 2D-and 3D-PISA methods as 15 (Table 4).…”

Section: Subgroup Analysis According To the Characteristics Of Mrmentioning

confidence: 99%

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Differential Effect of 3-Dimensional Color Doppler Echocardiography for the Quantification of Mitral Regurgitation According to the Severity and Characteristics

Choi

Heo

Hong

et al. 2014

Circ: Cardiovascular Imaging

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Although the flow quantification using 3D-CDE has been proposed to overcome the inherent limitations of 2D-CDE, 9,12-15 its technical limitations, such as multiple gated acquisition and time-consuming manual processing, prevent it from becoming widely adopted into daily clinical practice.Recently, advances in technology of 3D-CDE provide the option of semiautomated MR quantification based on the 3D-PISA method, and its results could be potentially more accurate than 2D-PISA method in quantifying MR. 16Background-The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR

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“…The anatomic regurgitant orifice area closely tracks the color Doppler-based VC area. 33 The latter can be now obtained from 3D color Doppler imaging by both transthoracic echocardiography and TEE. A VC area of ≥0.41 cm 2 seems to be indicative of severe MR although further validation of this cutoff is necessary given that the comparison standard in most has been conventional 2D estimates of severity of MR. Also, the cutoff value for what constitutes severe SMR may be lower than in degenerative MR. 34 Despite these limitations, VC area is probably more accurate than VC width by 2D in SMR.…”

Section: Newer Methods and Approachesmentioning

confidence: 99%

Imaging Challenges in Secondary Mitral Regurgitation

Lancellotti

Zamorano

Vannan

2014

Circ: Cardiovascular Imaging

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Direct Measurement of Proximal Isovelocity Surface Area by Single-Beat Three-Dimensional Color Doppler Echocardiography in Mitral Regurgitation: A Validation Study

Cited by 80 publications

References 39 publications

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

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

Differential Effect of 3-Dimensional Color Doppler Echocardiography for the Quantification of Mitral Regurgitation According to the Severity and Characteristics

Imaging Challenges in Secondary Mitral Regurgitation

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