Level of agreement in three‐dimensional planimetric measurement of mitral valve area between transthoracic and transesophageal echocardiography

Background Echocardiographic measurement of mitral valve area (MVA) is critical prior to percutaneous transmitral commissurotomy (PTMC). This study aimed to compare the agreement between transthoracic (TTE) and transesophageal echocardiography (TEE) in three‐dimensional (3D) planimetric measurement of theMVAamong patients with severe mitral stenosis. Methods MVAwas measured with planimetry in 105 patients before undergoingPTMC. 3D reconstruction was applied to bothTTEandTEEexaminations. TheMVAvalues from four different methods of 3D reconstruction were compared to the average values of 3D methods inTEEas the gold standard measurement method for theMVAin this study. The agreement levels between the two examinations were evaluated and analyzed for various reconstruction methods. Results The mean age was 49 ± 12 years for 28 men and 77 women who were enrolled. The image quality was graded as “excellent” in 57% of 3D images obtained byTTE, while it was graded as “excellent” in 81% of 3D images obtained byTEE. The ventricular zooming method inTTEwith a bias of −0.006 ± 0.065 cm2(P < 0.0001) had the highest agreement with the 3D‐MVAinTEE. While 2D‐TTEand 3D‐TEEmeasurements of theMVA(R = 0.91;P < 0.0001) were significantly correlated, 2D‐TTEoverestimated theMVAby 0.19 cm2. Conclusion Although the quality of 3D images was significantly better inTEEthan those inTTE, a good agreement existed between the measured 3D‐TTEand 3D‐TEEstudies. We also demonstrated that 2D‐TTEoverestimated theMVAcompare to 3D‐TEE.