Quantification of Mitral Regurgitation by the Proximal Flow Convergence Method—Comparison of Transthoracic and Transesophageal Echocardiography

Abstract

SummaryBackground: No data exist to indicate whether transthoracic (TTE) and transesophageal echocardiography (TEE) are of comparable value for the detection and quantification of mitral regurgitation using the proximal flow convergence method.Hypothesis: The study was performed to compare the value of TTE and TEE for the detection and quantification of mitral regurgitation using this method.Methods: The study included 57 patients with and 11 patients without mitral regurgitation. In all patients, the proximal flow convergence region was imaged by transthoracic and transesophageal color Doppler echocardiography, and proximal isovelocity surface area radii were determined. In 19 patients, monoplane TEE and in 49 patients multiplane TEE was performed. Thirty-one patients with mitral regurgitation underwent cardiac catheterization.Results: Both methods had a comparable sensitivity for the detection of mitral regurgitation. Proximal isovelocity surface area radii derived from TTE and TEE agreed moderately (mean difference Ϫ0.5 ± 1.3 mm). TTE and TEE correlated significantly with the angiographic grade (rank correlation coefficients 0.83 and 0.81), and both differentiated mild to moderate from severe mitral regurgitation with an accuracy of 90%. Regurgitant volumes derived from both echocardiographic techniques and cardiac catheterization correlated moderately (correlation coefficients between 0.67 and 0.81).

Quantitative assessment of mitral insufficiency: Its advantages and disadvantages

“…The images of sufficient quality to visualize PISA radius can be obtained in 92-98% of patients [63]. The optimal Nyquist limit corresponds to ∼10% of maximal regurgitation velocity, or approximately 30-40 cm/sec [59,64,65] Setting the Nyquist limit too high, would force the operator to use a PISA hemisphere close to the regurgitant orifice and would increase the error in assessing the EROA [66].…”

Echocardiography in newly diagnosed atrial fibrillation patients: a systematic review and economic evaluation

“…Of the 44 included studies, there were 17 studies 62,69,72,74,75,77,79,80,82,86,90,91,95,97,[100][101][102] that included AF patients in the population. Of these, for two studies 79,91 all participants had AF.…”

“…they differed from level 2 only in being among non-consecutive patients. Twenty-two of the studies were level 3b, 62,69,71,72,[77][78][79]82,[85][86][87]89,90,92,93,95,96,98,100,101,104,105 comparisons with a reference standard that did not meet criteria for higher levels of evidence. There were four diagnostic case-control studies, level 3c.…”

“…There were four diagnostic case-control studies, level 3c. 63,70,75,97 Considering only diagnostic accuracy studies with AF populations, there were three level 2 studies, 80,91,102 one level 3a study, 74 11 level 3b studies 62,69,72,77,79,82,86,90,95,100,101 and two level 3c studies. 75,97 As all AF population studies were included, and non-AF population studies selected according to hierarchy of evidence, this explains the higher proportion of level 2 and 3a studies with non-AF populations.…”

“…Twelve studies 64,65,68,69,[72][73][74][75]88,101,103,104 reported diagnostic accuracy of TTE in valvular heart disease ( Table 7). TTE was presumed gold standard for four studies of MR, 64,68 aortic stenosis, 64,68 mitral valve prolapse (MVP), 64 valvular heart disease, 64,88 aortic regurgitation (AR) 64,68 and tricuspid regurgitation.…”