Validation of a New Score for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

Anwar, Ashraf M.; Attia, Wael Mohamed; Nosir, Youssef F.M.; Soliman, Osama Ibrahim Ibrahim; Mosad, Mohammed A.; Othman, M.M.; Geleijnse, Marcel L.; El-Amin, Ali; Cate, Folkert J. ten

doi:10.1016/j.echo.2009.09.022

Cited by 82 publications

(72 citation statements)

References 39 publications

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“…Accordingly, using the RT3DE score may identify more patients with unsuitable anatomy for PTMV. 55 Accurate assessment of gap and width as well as billowing height and volume is necessary for selection of potential candidates for percutaneous MV repair using the MitraClip system. 56 Besides the site of prolapse, 3D TEE could provide a more precise quantification of the prolapse gap and width than 2D imaging (Figure 6).…”

Section: Guiding Transcatheter MV Intervention and Development Of Newmentioning

confidence: 99%

Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography

Lee

Fang

Jin

et al. 2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ysis yields faster and more reproducible results; and (4) a variety of users (eg, cardiac anesthetists) wants to use the repeatable methodology offered by quantitative methods. Image-processing tools provide characterization of the complex 3D morphology and motion of the MV. Combined with the properties of the imaging modality and knowledge of anatomy, this yields quantitative descriptions that are useful in diagnostic and therapeutic decision-making. This review summarizes the current development and applications of quantitative analysis of the MV morphology using RT3DE. Anatomic Consideration MV LeafletsThe anterior leaflet (AL) is in fibrous continuity with the aortic valve and guards one-third of the anterior mitral annulus. Fine demarcations divide the AL into 3 smaller scallops. The posterior leaflet (PL) is crescent-shaped and spans the posterior n the past 5 years, advances in real-time 3-dimensional echocardiography (RT3DE) have revolutionized the imaging of the mitral valve (MV). Many studies have consistently shown the superiority of 3D transesophageal echocardiography (TEE) over 2D TEE for visualizing MV morphology. 1 RT3DE has become the imaging modality of choice for guiding MV surgery and catheter-based intervention. Currently, RT3D imaging of the MV involves mainly visualization and qualitative interpretation of volume-rendered images. This "qualitative" approach typically involves few quantitative measurements of MV morphology, and is prone to subjectivity that introduces bias, low reproducibility, and high dependency on imaging expertise.Quantitative cardiac imaging has growing importance for several reasons: (1) as imaging becomes more digital, the opportunity will create the need; (2) automated approaches to intervention and surgery design and planning are emerging from the laboratory and entering the clinic; (3) algorithm-driven anal- The mitral valve (MV) has complex 3-dimensional (3D) morphology and motion. Advance in real-time 3D echocardiography (RT3DE) has revolutionized clinical imaging of the MV by providing clinicians with realistic visualization of the valve. Thus far, RT3DE of the MV structure and dynamics has adopted an approach that depends largely on subjective and qualitative interpretation of the 3D images of the valve, rather than objective and reproducible measurement. RT3DE combined with image-processing computer techniques provides precise segmentation and reliable quantification of the complex 3D morphology and rapid motion of the MV. This new approach to imaging may provide additional quantitative descriptions that are useful in diagnostic and therapeutic decision-making. Quantitative analysis of the MV using RT3DE has increased our understanding of the pathologic mechanism of degenerative, ischemic, functional, and rheumatic MV disease. Most recently, 3D morphologic quantification has entered into clinical use to provide more accurate diagnosis of MV disease and for plannin...

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Section: Guiding Transcatheter MV Intervention and Development Of Newmentioning

confidence: 99%

Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography

Lee

Fang

Jin

et al. 2014

Circ J

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“…[8][9][10][11][12][13][14][15] Several subsequent models that seek to include a prediction of MR have been proposed; however, the best combination of parameters to predict both outcome variables remains to be defined. 4,[16][17][18][19][20] Commissural morphology, in particular, asymmetrical commissural remodeling, and absolute leaflet displacement in diastole provide quantitative variables that are based on the fundamental mechanistic derangement of rheumatic mitral valve stenosis and can be reproducibly measured.…”

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confidence: 99%

The Echo Score Revisited

et al. 2014

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Background-Current echocardiographic scoring systems for percutaneous mitral valvuloplasty (PMV) have limitations.This study examined new, more quantitative methods for assessing valvular involvement and the combination of parameters that best predicts immediate and long-term outcome after PMV. Methods and Results-Two cohorts (derivation n=204 and validation n=121) of patients with symptomatic mitral stenosis undergoing PMV were studied. Mitral valve morphology was assessed by using both the conventional Wilkins qualitative parameters and novel quantitative parameters, including the ratio between the commissural areas and the maximal excursion of the leaflets from the annulus in diastole. Independent predictors of outcome were assigned a points value proportional to their regression coefficients: mitral valve area ≤1 cm 2 (2), maximum leaflets displacement ≤12 mm (3), commissural area ratio ≥1.25 (3), and subvalvular involvement (3). Three risk groups were defined: low (score of 0-3), intermediate (score of 5), and high (score of 6-11) with observed suboptimal PMV results of 16.9%, 56.3%, and 73.8%, respectively. The use of the same scoring system in the validation cohort yielded suboptimal PMV results of 11.8%, 72.7%, and 87.5% in the low-, intermediate-, and high-risk groups, respectively. The model improved risk classification in comparison with the Wilkins score (net reclassification improvement 45.2%; P<0.0001). Long-term outcome was predicted by age and postprocedural variables, including mitral regurgitation, mean gradient, and pulmonary pressure. Conclusions-A scoring system incorporating new quantitative echocardiographic parameters more accurately predicts outcome following PMV than existing models. Long-term post-PMV event-free survival was predicted by age, degree of mitral regurgitation, and postprocedural hemodynamic data. (Circulation. 2014;129:886-895.)

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“…A favorable Wilkins score (< 8 points) is highly predictive of an optimal outcome after PBMV [24,27,29]. Nevertheless, there are studies which have questioned the precision of this score as a predictor of the outcome and have suggested the Ragab A. Mahfouz et al, Echo score mitral stenosis, balloon valvuloplasty need for more refined and comprehensive echocardiographic assessments [28,30,31]. Many patients with MS may have limited symptoms despite unimpressive findings.…”

Section: Discussionmentioning

confidence: 99%

“…The Wilkins score is one of the most widely used echocardiographic scoring systems [24,26,28,29] and it provides a semi-quantitative assessment of mitral leaflets thickening, mobility, calcification, and the extent of the sub-valvular apparatus disease. A favorable Wilkins score (< 8 points) is highly predictive of an optimal outcome after PBMV [24,27,29].…”

Section: Discussionmentioning

confidence: 99%

Usefulness of the Global Echo-Doppler Score (GEDS) in selection of patients with mitral stenosis for percutaneous balloon mitral valvuloplasty

et al. 2014

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Validation of a New Score for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

Cited by 82 publications

References 39 publications

Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography

Quantification of Mitral Valve Morphology With Three-Dimensional Echocardiography

The Echo Score Revisited

Usefulness of the Global Echo-Doppler Score (GEDS) in selection of patients with mitral stenosis for percutaneous balloon mitral valvuloplasty

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