Determination of Regurgitant Orifice Area with the Use of a New Three-Dimensional Flow Convergence Geometric Assumption in Functional Mitral Regurgitation

2008 ◽  
Vol 21 (11) ◽  
pp. 1251-1256 ◽  
Author(s):  
Yoshiki Matsumura ◽  
Giuseppe Saracino ◽  
Kenichi Sugioka ◽  
Hung Tran ◽  
Neil L. Greenberg ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Three Dimensional ◽  
Functional Mitral Regurgitation ◽  
Three Dimensional Flow ◽  
Orifice Area ◽  
Dimensional Flow ◽  
Flow Convergence ◽  
Geometric Assumption ◽  
Regurgitant Orifice Area

scholarly journals A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area

2011 ◽  
Vol 301 (3) ◽  
pp. H1015-H1024 ◽  
Author(s):  
Sonal Chandra ◽  
Ivan S. Salgo ◽  
Lissa Sugeng ◽  
Lynn Weinert ◽  
Scott H. Settlemier ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Three Dimensional ◽  
3D Analysis ◽  
Element Analysis ◽  
Orifice Area ◽  
3D Transesophageal Echocardiography ◽  
3D Fea ◽  
Flow Convergence ◽  
Prototype Software ◽  
Regurgitant Orifice Area

Mitral effective regurgitant orifice area (EROA) using the flow convergence (FC) method is used to quantify the severity of mitral regurgitation (MR). However, it is challenging and prone to interobserver variability in complex valvular pathology. We hypothesized that real-time three-dimensional (3D) transesophageal echocardiography (RT3D TEE) derived anatomic regurgitant orifice area (AROA) can be a reasonable adjunct, irrespective of valvular geometry. Our goals were to 1) to determine the regurgitant orifice morphology and distance suitable for FC measurement using 3D computational flow dynamics and finite element analysis (FEA), and ( 2) to measure AROA from RT3D TEE and compare it with 2D FC derived EROA measurements. We studied 61 patients. EROA was calculated from 2D TEE images using the 2D-FC technique, and AROA was obtained from zoomed RT3DE TEE acquisitions using prototype software. 3D computational fluid dynamics by FEA were applied to 3D TEE images to determine the effects of mitral valve (MV) orifice geometry on FC pattern. 3D FEA analysis revealed that a central regurgitant orifice is suitable for FC measurements at an optimal distance from the orifice but complex MV orifice resulting in eccentric jets yielded nonaxisymmetric isovelocity contours close to the orifice where the assumptions underlying FC are problematic. EROA and AROA measurements correlated well ( r = 0.81) with a nonsignificant bias. However, in patients with eccentric MR, the bias was larger than in central MR. Intermeasurement variability was higher for the 2D FC technique than for RT3DE-based measurements. With its superior reproducibility, 3D analysis of the AROA is a useful alternative to quantify MR when 2D FC measurements are challenging.

scholarly journals 428 Prognostic implications of the relationship between effective regurgitant orifice area and left ventricle end diastolic volume in patients with functional mitral regurgitation treated with MitraClip

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Melillo ◽  
C Godino ◽  
F Ancona ◽  
A Sisinni ◽  
S Stella ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Clinical Outcome ◽  
Mitral Regurgitation ◽  
Primary Outcome ◽  
Functional Mitral Regurgitation ◽  
Orifice Area ◽  
End Diastolic Volume ◽  
Prognostic Implications ◽  
Regurgitant Orifice Area ◽  
The Relationship

Abstract Funding Acknowledgements none Background The distinction between proportionate and disproportionate functional mitral regurgitation (FMR), based on the relationship between effective regurgitant orifice area (EROA) and left ventricle end diastolic volume (LVEDV), has recently been proposed as a possible new clinical and physiopathological framework to identify patients that could likely benefit from transcatheter mitral repair. Purpose The aim of our study was to explore the possible prognostic implications of the EROA/LVEDV ratio in patients with FMR treated with MitraClip. Methods – Baseline EROA/LVEDV was calculated in 137 patients with at least moderate-to-severe, symptomatic FMR treated with MitraClip. All patients underwent clinical, biochemichal and echocardiographic evaluation before MitraClip. EROA was calculated using PISA method. The primary outcome was a composite end-point of all-cause death or re-hospitalization for heart failure (HF). Results – The median follow-up was 1.1 years. The primary outcome occurred in 59 patients (43 %). Population study showed a LVEDVi 113.52± 32.16 mL/m2, LVEF 29.75± 10.06% and EROA 39.45± 15.43 mm2.. The cut-off value of EROA/LVEDV ratio for primary outcome, identified by receiver operating characteristic curve, was 0.15 (AUC 0,65, p = 0.002) with a sensitivity and specificity of 78% and 52%, respectively. Patients were divided in two groups according to the identified cut-off. Patients with higher ratio (Group I, n = 88) presented a less dilated LV (LVEDVi: 105.1 ± 29.6 mL/m2 vs 128.2 ± 31.9 mL/m2, p < 0.001; LVESVi: 73.1 ± 27.7 mL/m2 vs 94.9 ± 29.05 mL/m2, p < 0.001), and a more severe MR (EROA: 47.9 ± 12.1 mm2 vs 25.1 ± 8.3 mm2, p < 0.001; vena contracta: 7.2 ± 1.3 mm vs 6.5 ± 1.3 mm, p = 0.008). There were no significant differences of left ventricle ejection fraction, right ventricle systolic function and systolic pulmonary pressure between the groups. At univariate analysis, EROA/LVEDV ratio >0.15 (HR = 2.223, 95% CI 1.121-4.411, p = 0.022), baseline evidence of atrial fibrillation (HR = 1.949, 95% CI 1.156-3.283, p = 0.012) and baseline pro-BNP (HR= 1.000, 95% CI 1.000-1.000, p = 0,001) were associated with a worse clinical outcome. At multivariate Cox-regression analysis, both EROA/LVEDV ratio >0.15 and baseline pro-BNP values were identified as independent predictors (HR 2.941, 95% CI 1.035-8.353, p = 0.043; HR = 1.000, 95% CI 1.000-1.000, p = 0.002, respectively). At Kaplan-Meier survival analysis, patients with EROA/LVEDV >0.15 had a significant lower freedom from composite endpoint (log-rank χ2 =5.517, p= 0.019; Fig. 1). Conclusion Our data show that EROA/LVEDV ratio was an independent predictor of adverse clinical outcome in FMR patients treated with MitraClip. This preliminary experience shows that this index could help to identify subgroups of patients with potential different clinical benefits from Mitraclip therapy. However, further and extended data are needed to provide more precise evidence. Abstract 428 Figure. Fig. 1

scholarly journals Three-dimensional flow influences on radar layer stratigraphy

2007 ◽  
Vol 46 ◽  
pp. 22-28 ◽  
Author(s):  
G.J.-M.C. Leysinger Vieli ◽  
R.C.A. Hindmarsh ◽  
M.J. Siegert
Keyword(s):  
Accumulation Rate ◽  
Flow Direction ◽  
Three Dimensional ◽  
Flow Mode ◽  
Lateral Velocity ◽  
Three Dimensional Flow ◽  
Near Surface ◽  
Dimensional Flow ◽  
Flow Convergence ◽  
Basal Melting

AbstractVariations in the depth of radar-detectable englacial layers (isochrones) are commonly used to assess past variability in accumulation rates, but little is known about the effect of internal and basal flow variations on isochrone deflections (e.g. bumps, troughs). In this paper, we show how the isochrones are affected by such variation using a three-dimensional flow model to investigate changes in the flow mode and in increased basal melting. We also investigate how transverse flows with lateral velocity gradients affect the development of isochrones. We use the model to visualize how such variations will be seen in radar lines which cross the flow direction. We show that in the presence of lateral gradients in the flow field we can produce bumps and troughs when viewed along transects perpendicular to the flow. The model results show that the influences of flow convergence, melting and changes in flow mode, when coupled together, affect isochrones over the whole depth of the ice sheet. Finally, changes in the near-surface layers cannot be solely attributed to spatial variation in the accumulation rate; there can also be a strong signal from changes in the flow mode.

P4728Prognostic implications of the relationship between effective regurgitant orifice area and left ventricle end diastolic volume in patients with functional mitral regurgitation treated with MitraClip

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Melillo ◽  
C Godino ◽  
F Ancona ◽  
A Sisinni ◽  
S Stella ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Clinical Outcome ◽  
Mitral Regurgitation ◽  
Primary Outcome ◽  
Functional Mitral Regurgitation ◽  
Severe Pulmonary Hypertension ◽  
Orifice Area ◽  
End Diastolic Volume ◽  
Regurgitant Orifice Area ◽  
The Relationship

Abstract Background The distinction between proportionate and disproportionate functional mitral regurgitation (FMR), based on the relationship between effective regurgitant orifice area (EROA) and left ventricle end diastolic volume (LVEDV), has recently been proposed as a possible new clinical and physiopathological concept to identify patients that could likely benefit from transcatheter mitral repair. Purpose The aim of our study was to explore the possible prognostic implications of the EROA/LVEDV ratio in patients with FMR treated with MitraClip. Methods Baseline EROA/LVEDV ratio was calculated in 72 patients with moderate-to-severe, symptomatic FMR treated with MitraClip. All patients underwent clinical, biochemichal and echocardiographic evaluation before MitraClip. EROA was calculated using PISA method. The primary outcome was a composite end-point of all-cause death or re-hospitalization for heart failure (HF). Results The median follow-up was 1 year. The primary outcome occurred in 25 patients (34.7%). The cut-off value of EROA/LVEDV ratio for primary outcome, identified by receiver operating characteristic curve, was 0.15 (p=0.007) with a sensitivity and specificity of 72 and 68%, respectively. Patients were divided in two groups according to the identified cut-off. Patients with higher ratio (Group I, n=35) presented a less dilated LV (LVEDVi: 113.2±33.4 mL vs 129.3±29.3 mL, p=0.033; LVESV: 140.7±49.0 mL vs 171.1±47.4 mL, p=0.010), a better LV systolic function (LVEF: 31.9±9.5% vs 27.8±5.8%, p=0.028) and a more severe MR (EROA: 44.5±12.9 mm2 vs 24.5±6.8 mm2, p<0.001; vena contracta: 7.4±1.5 mm vs 6.7±1.0 mm, p=0.045). Patients with lower ratio (Group II, n=37) showed a reduced prevalence of MV annular dilation (57.1% vs 91.7%, p=0.005) and a worse RV function (s'TDI: 9.2±2.2 cm/s vs 10.5±2.9 cm/s, p=0.039). At univariate analysis, EROA/LVEDV ratio >0.15 (HR = 2.467, 95% CI 1.017–5.982, p=0.046) and severe pulmonary hypertension (HR = 2.481, 95% CI 1.030–5.976, p=0.043) were associated with a worse clinical outcome. At multivariate Cox-regression analysis, both EROA/LVEDV ratio >0.15 and severe pulmonary hypertension were identified as independent predictors (HR 3.203, 95% CI 1–310–7.832, p=0.011; HR = 3.280, 95% CI 1.326–8.116, p=0.010, respectively). Figure 1 Conclusion Our data show that EROA/LVEDV ratio was an independent predictor of adverse clinical outcome in FMR patients treated with MitraClip. This preliminary experience shows that this index could help to identify subgroups of patients with potential different clinical benefits from MitraClip therapy. However, further and extended data are needed to provide more precise evidence. Acknowledgement/Funding None

scholarly journals Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation

1999 ◽  
Vol 33 (2) ◽  
pp. 538-545 ◽  
Author(s):  
Judy Hung ◽  
Yutaka Otsuji ◽  
Mark D Handschumacher ◽  
Ehud Schwammenthal ◽  
Robert A Levine
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Orifice Area ◽  
Area Variation ◽  
Regurgitant Orifice Area

scholarly journals The impact of different geometric assumption of mitral annular on the assessment of mitral regurgitation volume by Doppler method

2019 ◽  
Author(s):  
Wugang Wang ◽  
Zhibin Wang ◽  
Junfang Li ◽  
Kun Gong ◽  
Liang Zhao ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Three Dimensional ◽  
Reference Method ◽  
Mitral Annulus ◽  
Mean Difference ◽  
Significant Difference ◽  
Geometric Assumption ◽  
Three Dimensional Echocardiography ◽  
Regurgitant Orifice Area ◽  
The Impact

Abstract Background Mitral regurgitation volume (MRvol) by quantitative pulsed Doppler (QPD) method previously recommended suffers from geometric assumption error because of circular geometric assumption of mitral annulus (MA). Therefore, the aim of this study was to evaluate the impact of different geometric assumption of MA on the assessment of MRvol by two-dimensional transthoracic echocardiographic QPD method.Methods This study included 88 patients with varying degrees of mitral regurgitation (MR). The MRvol was evaluated by QPD method using circular or ellipse geometric assumption of MA. MRvol derived from effective regurgitant orifice area by real time three-dimensional echocardiography (RT3DE) multiplied by MR velocity-time integral was used as reference method.Results Assumption of a circular geometry of MA, QPD-MAA4C and QPD-MAPLAX overestimated the MRvol by a mean difference of 10.4 ml ( P < 0.0001) and 22.5 ml ( P < 0.0001) compared with RT3DE. Assumption of a ellipse geometry of MA, there was no significant difference of MRvol (mean difference = 1.7 ml, P = 0.0844) between the QPD-MAA4C+A2C and the RT3DE.Conclusions Assuming that the MA was circular geometry previously recommended, the MRvol by QPD-MAA4C was overestimated compared with the reference method. However, assuming that the MA was ellipse geometry, the MRvol by the QPD-MAA4C+A2C has no significant difference with the reference method.

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