Key result
Two-chamber calculated EROA underestimates measured en face EROA by ~17% but remains the preferred view.
Why the study?
Does calculated EROA using VCW accurately estimate measured en face EROA by RT3D echocardiography in dogs with MMVD?
Observational (n=158)
Does calculated EROA using VCW accurately estimate measured en face EROA by RT3D echocardiography in dogs with MMVD?
In dogs with myxomatous mitral valve disease, calculating EROA using the 2-chamber view vena contracta width provides the closest estimate to measured en face EROA by 3D echocardiography, though it still underestimates by 17%.
Supports preferring 2-chamber VCW-derived EROA in canine MMVD; leaves open outcome validation before clinical adoption.
Background Effective regurgitant orifice area (EROA), calculated from the vena contracta width (VCW) as the narrowest portion of the proximal regurgitant jet, might be used to estimate severity of mitral regurgitation. However, this simplified assumption only holds when the EROA is circular, which might not be true in dogs with myxomatous mitral valve disease (MMVD). Hypothesis Effective regurgitant orifice area in dogs with MMVD is noncircular, and using color Doppler real-time 3-dimensional (RT3D) echocardiography, measured EROA in the en face view will be significantly different from calculated EROA. Animals Hundred and fifty-eight privately owned dogs with naturally occurring MMVD. Materials and Methods Prospective observational study comparing en face view of EROA with calculated EROA using VCW in 4-chamber (4Ch) and 2-chamber (2Ch) view only or combined 4Ch and 2Ch views using RT3D echocardiography. Results The calculated EROA using the 2Ch view showed a systematic underestimation of 17% compared with the measured en face EROA corrected for body surface area. The calculated EROA using 4Ch and 4Ch + 2Ch views showed less agreement with the en face EROA, and the difference between methods increased with increasing EROA. The difference between calculated and measured EROA showed a systematic underestimation of the calculated EROA by 36% (4Ch) and 33% (4Ch + 2Ch), respectively, compared to measured en face EROA. Conclusion and Clinical Importance When replacing measured EROA with calculated EROA using VCW measurements, the 2Ch view is preferred in dogs with MMVD.
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Tidholm et al. (2017) conducted an observational in Myxomatous mitral valve disease (MMVD) (n=158). Calculated effective regurgitant orifice area (EROA) using vena contracta width vs. Measured en face EROA using real-time 3-dimensional echocardiography was evaluated on Agreement between calculated EROA and measured en face EROA. Calculated EROA using the 2-chamber view systematically underestimated measured en face EROA by 17%, which was preferred over the 4-chamber (36% underestimation) or combined views (33%).
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