Key result
Mitral leaflet separation index strongly correlates with 3D planimetry for mitral stenosis severity.
Why the study?
Mitral valve area by 3D TEE planimetry is the reference for mitral stenosis severity, but simpler methods like mitral leaflet separation index need evaluation for accuracy.
Does the Mitral Leaflet Separation Index (MLSI) measured by 2D TTE and 2D TEE accurately correlate with 3D MPR planimetry MVA in determining the severity of mitral stenosis?
Observational (n=72)
No
Does the Mitral Leaflet Separation Index (MLSI) measured by 2D TTE and 2D TEE accurately correlate with 3D MPR planimetry MVA in determining the severity of mitral stenosis?
Effect estimate: r = 0.96 for 2D TEE and r = 0.94 for 2D TTE
p-value: p=<0.01
Mitral leaflet separation index evaluated by simpler 2D echocardiography techniques correlates strongly with the more complex 3D multiplanar reconstruction, offering an accessible method for accurate mitral stenosis severity grading.
MLSI by 2D TTE or TEE may simplify mitral stenosis grading; supports further validation against 3D planimetry before routine use.
Introduction: Cardiologists use several echocardiographic methods to evaluate the Mitral Stenosis (MS) severity. Determination of mitral valve area (MVA) by three- dimensional transesophageal echocardiography (3D TEE) planimetry has the best correlation with anatomic area of the mitral orifice and is probably the reference method. This study was designed to examine the relationship between mitral leaflet separation index (MLSI) measured by TEE which is a simple and accessible method and MVA calculated by 3D Multiplanar reconstruction (3D-MPR) planimetry in TEE as the reference but less accessible method for evaluation the MLSI accuracy in prediction of the severity of MS. Methods: 72 patients with MS were included in this study. Exclusion criteria were suboptimal echocardiographic images, severe mitral valve calcification, artificial heart valves, a history of mitral valve repair surgery, or contraindications to TEE. After obtaining written informed consents from all patients. Comprehensive TTE and TEE were performed and MLSI by 2D TTE and 2D TEE and MVA by 3D MPR planimetry were assessed. SPSS version 25 was used for performing the analysis and a P-value less than 0.05 was considered statistically significant. Results: The average age of the patients was 57.81±12.22 and of the patients were female. There was a significant correlation between MVA by 3D MPR and MLSI 2D TTE (r=0.94, P<0.01) and MLSI 2D TEE (r=0.96, P<0.01) methods. Conclusion: MLSI 2D TTE and MLSI 2D TEE are positively correlated to MVA measured by 3D MPR planimetry and MLSI can be useful in discriminating different grades of MS severity.
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Hoshmand et al. (2026) conducted an observational in Mitral Stenosis (n=72). Mitral leaflet separation index (MLSI) measured by 2D TTE and 2D TEE vs. Mitral valve area (MVA) measured by 3D multiplanar reconstruction planimetry was evaluated on Correlation between MLSI and MVA calculated by 3D MPR planimetry (r = 0.96 for 2D TEE and r = 0.94 for 2D TTE, p=<0.01). Mitral leaflet separation index measured by 2D TEE (r=0.96) and 2D TTE (r=0.94) strongly correlated with 3D MPR planimetry mitral valve area for evaluating mitral stenosis severity.
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