Key result
3-dimensional color Doppler echocardiography (3D-PISA) yielded significantly higher mitral regurgitation volumes than 2D-PISA (59.5 vs 52.4 mL; P=0.005), which often underestimated MR severity.
Why the study?
Does 3D-color Doppler echocardiography provide more accurate quantification of mitral regurgitation compared to 2D-color Doppler echocardiography in patients with MR?
Observational (n=221)
Does 3D-color Doppler echocardiography provide more accurate quantification of mitral regurgitation compared to 2D-color Doppler echocardiography in patients with MR?
3D-PISA is more accurate than 2D-PISA for quantifying mitral regurgitation, particularly in cases with severe, eccentric MR or asymmetrical orifices, where 2D-PISA significantly underestimates severity.
3D color Doppler is feasible for MR quantification in most patients; leaves open accuracy validation before clinical use.
BACKGROUND: The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography-based MR quantification has well-documented limitations. METHODS AND RESULTS: We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-color Doppler echocardiography in 211 (95.5%) patients. The quantitative differences between the MR volumes obtained by 2D- and 3D-proximal isovelocity surface area (PISA) were analyzed in various MR subgroups. In the validation cohort (n=52), MR volume obtained by 3D-PISA showed a better agreement with phase-contrast cardiac MRI than 2D-PISA (r=0.97 versus 0.84). In all 211 patients, 2D-PISA underestimated the MR volume when compared with 3D-PISA (52.4±19.6 versus 59.5±25.6 mL; P=0.005). A total of 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having nonsevere MR. In the subgroup analysis, the MR severity (odds ratio, 6.96; 95% confidence interval, 3.04-15.94; P<0.001) and having an asymmetrical orifice (odds ratio, 11.48; 95% confidence interval, 3.72-35.4; P<0.001), and an eccentric jet (odds ratio, 3.82; 95% confidence interval, 1.27-11.48; P=0.017) were predictors of significant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods. CONCLUSIONS: Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetrical orifice. This article demonstrates that 3D-color Doppler echocardiography could be used as a valuable tool to confirm treatment strategy in patients with significant MR.
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Choi et al. (2014) conducted an observational in Mitral regurgitation (n=221). 3-dimensional color Doppler echocardiography (3D-PISA) vs. 2-dimensional color Doppler echocardiography (2D-PISA) was evaluated on Mitral regurgitation volume (p=0.005). 3-dimensional color Doppler echocardiography (3D-PISA) yielded significantly higher mitral regurgitation volumes than 2D-PISA (59.5 vs 52.4 mL; P=0.005), which often underestimated MR severity.
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