Quantification of Mitral Regurgitation: A Comparison of Transesophageal Echocardiography and Contrast Ventriculography

Transesophageal echocardiography (TEE) allows an unobscured view of the left atrium for the assessment of mitral regurgitation (MR). However, criteria for assessing MR by TEE have not been carefully validated. In order to determine and validate criteria for the assessment of MR severity, 65 clinically stable patients with a TEE color Doppler study and contrast ventriculography within a 2-week period were identified. Maximal or peak mitral regurgitation jet area to left atrial area ratio (MR/LA) derived solely from TEE imaging had the best correlation to MR severity by contrast ventriculography (r = 0.89). Utilizing MR jet area without correction for LA size resulted in r = 0.72 to 0.75. Utilizing LA area data from transthoracic echocardiograms in a subset of 29 patients resulted in r = 0.77. Best sensitivity and specificity for the assessment of MR by TEE were obtained using the following criteria: Peak MR/LA of 0%-9% predicts 0 + MR; 10%-28% 1 + MR; 29%-54% 2 + to 3 + MR; and greater than 55% 4 + MR. Best sensitivity and specificity occurs for assessment of 0 + and 4 + MR. Considerable overlap in data occurs in the 1 + and 3 + MR range utilizing the above stated criteria. Peak MR/LA ratio derived from a single TEE view in which the MR jet is maximally imaged is the best determinant of MR severity.