Key result
Computer modeling demonstrated that the hemielliptic PISA method yields the smallest error (within 15%) for moderate and severe mitral regurgitation compared with other PISA methods.
Why the study?
Echocardiographic quantification of mitral regurgitation may significantly underestimate or overestimate regurgitant volume, particularly with 2D echocardiography.
Does the corrected volumetric technique improve the accuracy of primary mitral regurgitation quantification compared to PISA methods in computer models?
Does the corrected volumetric technique improve the accuracy of primary mitral regurgitation quantification compared to PISA methods in computer models?
Computer modeling demonstrates that a corrected volumetric technique is theoretically more robust and accurate than PISA methods for quantifying primary mitral regurgitation.
Answers are grounded in this paper and cite their sources.
May improve modeled mitral regurgitation quantification accuracy; leaves open need for clinical validation before practice adoption.
Clinical investigations have demonstrated that mitral regurgitation (MR) quantification using echocardiography (echo) may significantly underestimate or overestimate the regurgitant volume, especially for two-dimensional (2D) echo. Computer modeling and simulated echo were conducted to evaluate the fundamental assumptions in the echo quantification of primary MR that is due to posterior mitral leaflet prolapse. The theoretical flaw of the proximal isovelocity surface area (PISA) method originates from the assumption that the MR flow rate is the product of the isovelocity surface area and aliasing velocity, which is only valid when the velocity vectors are perpendicular to the isovelocity surface. Other factors such as the Doppler angle effect, the view planes of 2D echo, and the single time instant of PISA were also analyzed. We find that the hemielliptic PISA method gives the smallest error for moderate and severe MR cases compared with other PISA methods. Compared with the PISA method, the volumetric technique (VT) is theoretically more robust. By considering correction factors that are caused by nonflat velocity profiles and the closing volume of the aortic valve, the accuracy of the VT method can be significantly improved. The corrected volumetric technique provides more accurate results compared with the PISA methods, especially for mild MR. NEW & NOTEWORTHY We evaluate the accuracy of common echocardiography techniques for the quantification of primary mitral regurgitations using computer modeling. The hemielliptic proximal isovelocity surface area (PISA) method gives the smallest error (within 15%) for moderate and severe mitral regurgitation cases compared with other PISA methods. The volumetric method is theoretically more robust than the PISA method. The accuracy of the volumetric method can be improved by a correction factor around 0.7 because of the nonflat velocity profiles and the closing volume of the aortic valve.
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Mao et al. (2020) studied Primary mitral regurgitation. Computer modeling and simulated echocardiography vs. Standard PISA methods was evaluated on Error in quantification of regurgitant volume. Computer modeling demonstrated that the hemielliptic PISA method yields the smallest error (within 15%) for moderate and severe mitral regurgitation compared with other PISA methods.
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