What is the clinical evidence from this study?

Study design: Observational. Population: Mitral regurgitation (n=500). Intervention: Vena contracta area (VCA3D) by 3D colour Doppler vs. Effective regurgitant orifice area (EROAPISA). Primary outcome: Prediction of severe mitral regurgitation (Area under the ROC curve) (p=<0.001).

March 9, 2017Open Access

Vena contracta area for severity grading in functional and degenerative mitral regurgitation: a transoesophageal 3D colour Doppler analysis in 500 patients

Q: What are the key findings of this study?

VCA3D derived by 3D colour Doppler yielded a higher area under the ROC curve for predicting severe mitral regurgitation compared to EROAPISA (0.98 vs. 0.90, P<0.001).

Key Result

VCA3D derived by 3D colour Doppler yielded a higher area under the ROC curve for predicting severe mitral regurgitation compared to EROAPISA (0.98 vs. 0.90, P<0.001).

Study Design

Type

Observational (n=500)

Structured PICO

Does VCA3D derived by 3D colour Doppler echocardiography improve the prediction of severe mitral regurgitation compared to 2D parameters in patients with FMR and DMR?

Population

500 patients with functional (FMR) and degenerative mitral regurgitation (DMR)

Intervention

Vena contracta area (VCA3D) derived by 3D colour Doppler transoesophageal echocardiography

Comparator

2D echocardiographic parameters (vena contracta width, EROAPISA, RVPISA)

Outcome

Prediction of severe MR and correlation of regurgitation volume with reference 3D methodsurrogate

VCA3D derived by 3D transoesophageal echocardiography is a robust parameter for quantifying mitral regurgitation severity, outperforming standard 2D PISA methods.

Main Result

Absolute Event Rate: 0.98% vs 0.9%

p-value: p=<0.001

Abstract

Aims: Vena contracta area (VCA3D), derived by 3D colour Doppler echocardiography, has already been validated against cardiac magnetic resonance imaging, but the number of clinical studies to define cut-off values for grading of mitral regurgitation (MR) is limited. Aim of the study was to assess VCA3D in a large population of patients with functional (FMR) and degenerative MR (DMR). Methods and results: Transoesophageal echocardiography was performed in 500 patients with MR. The following 2D parameters were assessed for grading of MR: vena contracta width, effective regurgitant orifice area (EROAPISA), and regurgitation volume (RVPISA). VCA3D and the corresponding regurgitation volume (RVVCA) were quantified using 3D colour Doppler loop and CW Doppler tracing of the regurgitant jet. In 104 patients a 3D dataset of the left ventricle (LV) and the left ventricular outflow tract (LVOT) was acquired. As a reference method, regurgitation volume (RV3D) was calculated as difference between LV overall and LVOT stroke volumes. For prediction of severe MR, VCA3D yielded higher values of area under the ROC curve compared to EROAPISA (overall patient group 0.98 for VCA3D vs. 0.90 for EROAPISA, P < 0.001; FMR group 0.97 for VCA3D vs. 0.92 for EROAPISA, P = 0.002). RVVCA correlated closer with RV3D compared to RVPISA (r = 0.96 for RVPISA, r = 0.79 for RVPISA). Conclusion: This study delivers cut-off values for VCA3D in patients with different types of MR. VCA3D is a robust parameter for quantification of MR, showing a good correlation with the reference method using 3D datasets of LV.