Direct Quantification of Mitral Regurgitant Flow Volume by Real-Time Three-Dimensional Echocardiography Using Dealiasing of Color Doppler Flow at the Vena Contracta

Plicht, Björn; Kahlert, Philipp; Goldwasser, Ranny; Janosi, Rolf-Alexander; Hunold, Peter; Erbel, Raimund; Buck, Thomas

doi:10.1016/j.echo.2008.09.022

Cited by 44 publications

(31 citation statements)

References 46 publications

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“…The relatively smaller EROA by 2D compared with 3D method is likely because of greater underestimation of EROA for 2 large asymmetrical orifices by 2D PISA and the errors in 2D PISA radius measurements because of the challenges in identifying the center of the regurgitant orifices particularly in the in vitro model. Also similar to previous 2D studies 10 but different from all previous 3D PISA publications, [5][6][7][8][9]12 this study compared the use of 3D peak and integrated PISA methods to quantify MR RVol. In the in vitro model, the RVol by the 3D peak and integrated PISA methods was accurate, whereas the 2D RVol was underestimated by 50%.…”

Section: Automated 3d Pisa-based Eroa and Rvolsupporting

confidence: 51%

“…The latter is specifically important in patients with functional MR where the regurgitant orifice is thought to be largest at the beginning and end of systole and smallest in the middle. 10,13 Although previous studies have shown that 3D methods are more accurate than 2D PISA methods for MR quantification, these studies either required significant manual interaction with the data or ongoing geometric assumptions [5][6][7][8][9] and were unable to account for the dynamic nature of the regurgitant orifice. [5][6][7][8][9]12 In this study, the 3D PISA was measured in an automated method without making any specific geometric assumptions.…”

Section: Automated 3d Pisa-based Eroa and Rvolmentioning

confidence: 99%

“…3,4 Although 3-dimensional (3D) echocardiography-based PISA techniques have been shown to be more accurate, [5][6][7][8][9] it is not widely used because of limitations of gated acquisitions, the need for time-consuming manual interaction with the data, and ongoing need for shape assumptions. Also, current 3D PISA techniques do not account for the dynamic nature of the regurgitant orifice, which is especially important in functional MR.…”

mentioning

confidence: 99%

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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: Automated 3d Pisa-based Eroa and Rvolsupporting

confidence: 51%

Section: Automated 3d Pisa-based Eroa and Rvolmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Several in vitro and in vivo studies have compared the accuracy of 2D and 3D color Doppler techniques to quantify mitral regurgitant volume against reference methods (flowmeter standard and MRI). 6,[21][22][23] Three-dimensional color Doppler echocardiography resulted in less regurgitant volume underestimation for all orifice shapes tested compared with the 2D flow-convergence method. 6,[21][22][23] Similar results were obtained in clinical studies in which the assumption of a hemispherical shape of the regurgitant orifice by 2D echocardiography significantly underestimated the flow rate by 35% to 44%.…”

Section: Quantification Of Mitral Regurgitation Using 2d Versus 3d Teementioning

confidence: 99%

Quantitative Assessment of Mitral Regurgitation

Shanks

Siebelink

Delgado

et al. 2010

Circ: Cardiovascular Imaging

123

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Background-Quantification of mitral regurgitation severity with 2-dimensional (2D) imaging techniques remains challenging. The present study compared the accuracy of 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE for quantification of mitral regurgitation, using MRI as the reference method. Methods and Results-Two-dimensional and 3D TEE and cardiac MRI were performed in 30 patients with mitral regurgitation.Mitral effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were estimated with 2D and 3D TEE. With 3D TEE, EROA was calculated using planimetry of the color Doppler flow from en face views and Rvol was derived by multiplying the EROA by the velocity time integral of the regurgitant jet. Finally, using MRI, mitral Rvol was quantified by subtracting the aortic flow volume from left ventricular stroke volume. Compared with 3D TEE, 2D TEE underestimated the EROA by a mean of 0.13 cm

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“…The velocity ambiguity cannot be overcome just by ultrasound data especially when true velocity is several multiples of the Nyquist level [2]. To address this issue, various approaches have been proposed using customized hardware [3] or certain geometric assumptions [4,5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Automatic cardiac flow quantification on 3D volume color Doppler data

Wang

Georgescu

Datta

et al. 2011

2011 IEEE International Symposium on Biomedical Imaging: From Nano to Macro

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Valvular heart diseases are recognized as a significant cause of morbidity and mortality. Accurate quantification of cardiac flow volumes in patients is essential in evaluation of the progression of the disease and in determination of clinical options. Recent advances in the real-time 3D full volume echocardiography have enabled high frame rate acquisition of volumetric color Doppler flow images. In this paper, we propose a fully automated method to quantify the cardiac flow using instantaneous 3D+t ultrasound data. The anatomical information such as mitral annulus and left ventricle outflow tract (LVOT) are detected and tracked automatically accounting for the heart motion. Furthermore, the proposed method automatically detects and tracks the endocardial boundary of the left ventricle (LV) and computes the instantaneous change in LV volume. This information is used to overcome inherent limitation of the color Doppler velocity ambiguity such that de-aliasing parameters are computed and used to correct flow computations. Preliminary results with clinical data presented here agree well with accepted clinical measurements in a quantitative manner. The proposed method is efficient and achieves high speed performance of 0.2 second per volume of ultrasound data.

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Direct Quantification of Mitral Regurgitant Flow Volume by Real-Time Three-Dimensional Echocardiography Using Dealiasing of Color Doppler Flow at the Vena Contracta

Cited by 44 publications

References 46 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

Quantitative Assessment of Mitral Regurgitation

Automatic cardiac flow quantification on 3D volume color Doppler data

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