Key result
Mitral-aortic VTI ratio accurately discriminates severe isolated mitral regurgitation with an AUC of 0.94.
Why the study?
Echocardiographic quantification of MR remains challenging and is limited by geometric assumptions, prompting investigation into whether the mitral-aortic or mitral-pulmonary VTI ratio can feasibility and accurately discriminate severe isolated MR.
Does the mitral-aortic or mitral-pulmonary VTI ratio accurately discriminate severe isolated mitral regurgitation compared to standard echocardiographic parameters?
Observational (n=166)
Blinded readers
No
Does the mitral-aortic or mitral-pulmonary VTI ratio accurately discriminate severe isolated mitral regurgitation compared to standard echocardiographic parameters?
The mitral-aortic and mitral-pulmonary VTI ratios are simple, reproducible echocardiographic parameters that provide excellent discrimination for severe isolated mitral regurgitation, outperforming several standard measures.
Answers are grounded in this paper and cite their sources.
May aid echocardiographic grading of severe MR; leaves open prospective validation against outcomes.
Echocardiographic quantification of mitral regurgitation (MR) remains challenging, requiring dedicated image acquisition, and is limited by potential error from geometric assumptions of annular dimensions. Volume is a product of area and flow and assuming proportional mitral/aortic areas, an increased mitral-inflow volume compared to LV/RV-outflow semi-quantitatively represents greater MR regurgitant volume. Therefore, we investigated the feasibility and diagnostic performance of the mitral-aortic velocity-time integral(VTI) ratio in isolated MR. We also investigated the use of the mitral-pulmonary VTI ratio as an alternative in clinical situations where the LV outflow tract(LVOT) VTI could not be used. We reviewed 166 consecutive patients (33%, n = 54 severe MR by multi-parameter integrated expert opinion). Pulsed wave Doppler VTI at the mitral leaflet tips and the left ventricular outflow and continuous-wave Doppler of the RV outflow tract were measured individually and independently by blinded readers(expert and trainee status) to derive the ratio. Receiver operator characteristic area under the curve(AUC) comparison was calculated and compared with effective regurgitant orifice area(EROA > 40 mm), regurgitant volume(RVol > 60mL), vena contracta(VC > 0.7 cm), E-velocity > 1.2 cm, systolic flow reversal(SFR), left atrial and ventricular dilatation. Increasing ratio was associated with severe MR(AUC 0.94) with optimal threshold defined at 1.3. This provided significant discrimination for severe MR(AUC 0.81) compared to EROA(0.68), VC(0.52), LV dilatation(0.69), LA dilatation(0.70), SFR(0.73), E-velocity(0.68) all p < 0.05, with sensitivity 82% and specificity 94%. The mitral-pulmonary VTI ratio demonstrated similar discrimination(AUC 0.92) with optimal threshold defined at 1.14. Excellent inter-observer reproducibility(intra-class correlation 0.97) was seen between trainee and expert readers. There was no difference in AUC comparison by MR mechanism or patient rhythm. The mitral-aortic and mitral-pulmonary VTI ratios are simple, geometric-free parameters feasibly reproducible from routine echocardiographic datasets and are excellent discriminative tools for severe MR. Readers should consider integration of this parameter in routine reporting.
No takes yet. Share an insight, caveat, or question.
Nerlekar et al. (2024) conducted an observational in Severe isolated mitral regurgitation (n=166). Mitral-aortic velocity-time integral (VTI) ratio vs. Standard echocardiographic parameters (EROA, vena contracta, etc.) was evaluated on Severe mitral regurgitation (OR 1.97, 95% CI 1.59-2.43, p=<0.001). The mitral-aortic velocity-time integral ratio accurately discriminated severe isolated mitral regurgitation with an area under the curve of 0.94 and an optimal threshold of 1.26.
Synapse has enriched 10 related papers. Consider them for comparative context: