Key result
3D TTE yields ~14% lower sensitivity than standard 2D for detecting prolapsing mitral valve scallops.
Why the study?
How do 2D xPlane imaging and 3D TTE compare to standard 2D TTE for identifying the site and extent of mitral valve prolapse?
Observational (n=50)
Single-blind
No
How do 2D xPlane imaging and 3D TTE compare to standard 2D TTE for identifying the site and extent of mitral valve prolapse?
2D xPlane imaging is an accurate and reliable modality for assessing the site and extent of mitral valve prolapse, whereas 3D TTE showed lower sensitivity than standard 2D TTE in this cohort.
2D xPlane may support accurate mitral prolapse assessment; leaves open 3D TTE utility given lower sensitivity in this cross-sectional study.
This study sought to assess the value of two-dimensional (2D) transthoracic echocardiography (TTE), 2D xPlane imaging and three-dimensional (3D) TTE for the definition of the site and the extent of mitral valve (MV) prolapse. Fifty patients underwent transthoracic 2D, 2D xPlane and 3D echocardiography. With 2D xPlane a segmental analysis of the MV was performed, by making a lateral sweep across the MV coaptation line as seen in the parasternal short-axis view. Inter-observer agreement for specific scallop prolapse was for 2D xPlane excellent (97%, kappa = 0.94) and for 3D TTE moderate (85%, kappa = 0.67). The respective sensitivities of standard 2D TTE, 2D xPlane, and 3D TTE for the identification of the precise posterior scallop prolapse were for P1 92, 85, and 92%, for P2 96, 96, and 82%, and for P3 86, 81, and 71%. In total, 5 (8%) prolapsing MV scallops were missed by 2D TTE, 7 (12%) by 2D xPlane, and 12 (20%) by 3D TTE. The sensitivity of 3D TTE was significantly lower than standard 2D imaging (80% versus 93%, P < 0.05). The extent of P2 prolapse was under or overestimated in 5 patients with 2D xPlane and in 9 patients with 3D TTE. 2D xPlane imaging is an accurate, easy to use (compared to 3D TTE) and easy to interpret (compared to 2D and 3D TTE) imaging modality to study the site and the extent of MV prolapse.
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McGhie et al. (2015) conducted an observational in Mitral valve prolapse with severe mitral regurgitation (n=50). 2D xPlane and 3D transthoracic echocardiography vs. Standard 2D transthoracic echocardiography was evaluated on Sensitivity for identification of prolapsing mitral valve scallops (p=<0.05). 3D TTE showed significantly lower sensitivity for detecting prolapsing mitral valve scallops than standard 2D imaging (80% vs 93%, P<0.05), while 2D xPlane accurately assessed prolapse site and extent.
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