Quantification of regurgitation in mitral valve prolapse with automated real time echocardiographic 3D proximal isovelocity surface area: multimodality consistency and role of eccentricity index
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Key result
Automated 3D-PISA echocardiography provided similar regurgitant volume estimates compared to standard 2D-PISA in the overall mitral valve prolapse population (mean difference 5.7 ml, p=0.08), but significantly overestimated regurgitation in patients with asymmetric flow convergence regions.
Why the study?
Data assessing mitral regurgitation severity in mitral valve prolapse using 3D-PISA are scarce.
Does 3D-PISA accurately quantify regurgitant volume compared to 2D-PISA and CMR in patients with mitral valve prolapse?
Population
54 patients with MVP
Comparison
3D-PISA vs 2D-PISA and CMR
Authors
Discussion
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Implication
3D-PISA warrants caution in asymmetric flow convergence; leaves open accuracy versus CMR in mitral valve prolapse.
Key Points
- To evaluate the effectiveness of the 3D proximal isovelocity surface area (3D-PISA) method in quantifying regurgitation severity in mitral valve prolapse (MVP).
- Evaluated the 3D-PISA method in 54 patients with MVP.
- Compared results with 2D-PISA and cardiovascular magnetic resonance (CMR).
- Assessed the role of eccentricity index in flow convergence region.
- 3D-PISA showed strong correlation with 2D-PISA (r = 0.86) and CMR (r = 0.81).
- In patients with asymmetric flow convergence (n = 21), 3D-PISA RVol was significantly higher than 2D-PISA (93 ml vs 72 ml, p = 0.001).
- 3D-PISA demonstrated excellent reliability (ICC 0.91-0.99) with lower coefficient of variation (8%-10%) compared to 2D-PISA (12%-16%).
Study Design
Type
Observational (n=54)
Blinding
Single-blind
Multicenter
No
Structured PICO
Does 3D-PISA accurately quantify regurgitant volume compared to 2D-PISA and CMR in patients with mitral valve prolapse?
P
Population
54 adult patients with sinus rhythm and Carpentier type II degenerative mitral regurgitation who underwent evaluation with 2D-TTE, 3D-TTE, and CMR.
E
Exposure
Three-dimensional transthoracic echocardiography (3D-TTE) using semi-automated proximal isovelocity surface area method (3D-PISA)
C
Comparator
Two-dimensional PISA (2D-PISA) and cardiovascular magnetic resonance (CMR)
O
Outcome
Regurgitant volume (RVol) correlation and mean differences between 3D-PISA, 2D-PISA, and CMRsurrogate
Main Result
Mean Difference: 5.7 (95% CI -0.6–12)
Absolute Event Rate: 79% vs 73%
p-value: p=0.08
3D-PISA provides analogous evaluation of mitral regurgitation compared to 2D-PISA but overestimates regurgitant volume in cases of asymmetric flow convergence or when compared to CMR.
Limitations
- Studies were not performed simultaneously, potentially leading to differences in hemodynamic conditions
- Did not evaluate integrated 3D-PISA approach instead of peak 3D-PISA
- Relatively small study size which may introduce selection biases
Cite This Study
Spampinato et al. (2021) conducted an observational in Mitral valve prolapse with organic mitral regurgitation (n=54). 3D-PISA echocardiography vs. 2D-PISA echocardiography and Cardiovascular Magnetic Resonance was evaluated on Mean difference in regurgitant volume (RVol) between 3D-PISA and 2D-PISA (MD 5.7 ml, 95% CI -0.6 to 12, p=0.08). Automated 3D-PISA echocardiography provided similar regurgitant volume estimates compared to standard 2D-PISA in the overall mitral valve prolapse population (mean difference 5.7 ml, p=0.08), but significantly overestimated regurgitation in patients with asymmetric flow convergence regions.
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