Plausible Functional Diagnostics by Rational Echocardiography in the Assessment of Valvular Heart Disease - Role of Quantitative Echocardiography in the Assessment of Mitral Regurgitation

Hagendorff, Andreas; Stöbe, Stephan

doi:10.3389/fcvm.2022.819915

Cited by 3 publications

(1 citation statement)

References 39 publications

(73 reference statements)

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“…Plausible explanations for lower cardiac volumes by native 2D echocardiography in comparison with 2D contrast and native 3D echocardiography as well as with cardiac MRI in the clinical setting [ 55 , 57 , 58 ] are methodological errors due to foreshortening or differing contour delineations of the endocardium and limitations due to spatial resolution. In contrast to these previous studies, recent communications and trials using modern ultrasound technologies showed that comprehensive echocardiography can provide reliable and verifiable cardiac volume measurements by planimetry/volumetry as well as by Doppler echocardiography to correctly characterize cardiac hemodynamics [ 18 , 59 – 62 ]. In conclusion, using a definitive quantitative approach to grade the severity of valvular regurgitation includes the acceptance of the requirements to properly and plausibly determine LV volumes by echocardiography.…”

Section: Introductionmentioning

confidence: 99%

Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography

Hagendorff¹,

Helfen

Brandt

et al. 2023

Clin Res Cardiol

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The assessment of valvular pathologies in multiple valvular heart disease by echocardiography remains challenging. Data on echocardiographic assessment—especially in patients with combined aortic and mitral regurgitation—are rare in the literature. The proposed integrative approach using semi-quantitative parameters to grade the severity of regurgitation often yields inconsistent findings and results in misinterpretation. Therefore, this proposal aims to focus on a practical systematic echocardiographic analysis to understand the pathophysiology and hemodynamics in patients with combined aortic and mitral regurgitation. The quantitative approach of grading the regurgitant severity of each compound might be helpful in elucidating the scenario in combined aortic and mitral regurgitation. To this end, both the individual regurgitant fraction of each valve and the total regurgitant fraction of both valves must be determined. This work also outlines the methodological issues and limitations of the quantitative approach by echocardiography. Finally, we present a proposal that enables verifiable assessment of regurgitant fractions. The overall interpretation of echocardiographic results includes the symptomatology of patients with combined aortic and mitral regurgitation and the individual treatment options with respect to their individual risk. In summary, a reproducible, verifiable, and transparent in-depth echocardiographic investigation might ensure consistent hemodynamic plausibility of the quantitative results in patients with combined aortic and mitral regurgitation. Graphic abstract The quantitative approach to assess LV volumes in combined AR and MR patients: explanation and algorithm of how to determine the relevant target parameters. LVSVeff—effective left ventricular (LV) stroke volume, LVSVforward—forward LV stroke volume through the aortic valve (AV), LVSVtot—total LV stroke volume, RegVolAR—regurgitant volume through the AV, RegVolMR—regurgitant volume through the mitral valve (MV), LVfilling volume = LVMV-Inflow − transmitral LV inflow, LVOT—left ventricular outflow tract, RFAR—regurgitant fraction of aortic regurgitation (AR), RFMR—regurgitant fraction of mitral regurgitation (MR), RVSVeff —effective right ventricular (RV) stroke volume, RVSVforward—forward RV stroke volume through the pulmonary valve, RVSVtot—total RV stroke volume.

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Section: Introductionmentioning

confidence: 99%

Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography

Hagendorff¹,

Helfen

Brandt

et al. 2023

Clin Res Cardiol

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Timing of Surgery for Asymptomatic Primary Mitral Regurgitation: Possible Value of Early, Serial Measurements of Left Ventricular Sphericity

Stanley,

Athanasuleas

2024

CCR

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Abstract:: Asymptomatic primary mitral regurgitation due to myxomatous degeneration of the mitral valve leaflets may remain so for long periods, even as left ventricular function progresses to a decompensated stage. During the early compensated stage, the ventricle’s initial response to the volume overload is an asymmetric increase in the diastolic short axis dimension, accomplished by a diastolic shift of the interventricular septum into the right ventricular cavity, creating a more spherical left ventricular diastolic shape, increasing diastolic filling and stroke volume. Early valve repair is recommended to reduce postoperative left ventricular dysfunction. Early serial measurements of left ventricular sphericity index [LV-Si]. during the compensated stage of mitral regurgitation might identify subtle changes in left ventricular shape and assist in determining the optimal earliest timing for surgical intervention.

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Quantification of primary mitral regurgitation by echocardiography: A practical appraisal

Altes

Vermès²,

Lévy³

et al. 2023

Front. Cardiovasc. Med.

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The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.

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Plausible Functional Diagnostics by Rational Echocardiography in the Assessment of Valvular Heart Disease - Role of Quantitative Echocardiography in the Assessment of Mitral Regurgitation

Cited by 3 publications

References 39 publications

Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography

Expert proposal to analyze the combination of aortic and mitral regurgitation in multiple valvular heart disease by comprehensive echocardiography

Timing of Surgery for Asymptomatic Primary Mitral Regurgitation: Possible Value of Early, Serial Measurements of Left Ventricular Sphericity

Quantification of primary mitral regurgitation by echocardiography: A practical appraisal

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