Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Vena Contracta Area in Mitral Regurgitation

Introduction: 3D color Doppler allows a direct measurement of Vena Contracta (VC) area in patients with mitral regurgitation (MR), without the need for geometric assumptions. Hypothesis: 3D color Doppler VC area provides a more accurate assessment of MR severity than the conventional 2D color Doppler VC diameter. Methods: Patients with ≥ mild MR underwent 2D and 3D color Doppler and a quantitative echo-Doppler study. 2D VC diameter was measured from a zoomed parasternal long-axis view. 3D VC area was acquired using real-time 3D (Philips) and measured off-line (TomTec). MR severity was assessed both quantitatively, as effective regurgitant orifice area from pulsed Doppler [EROA = (mitral stroke volume - aortic stroke volume)/MR time velocity integral], and semi-quantitatively as recommended by the American Society of Echocardiography. Results: 61 patients (65 ± 15 years) were studied. MR severity was mild in 25%, moderate in 36%, and moderate to severe or severe in 39%. Mitral valve pathology was prolapse in 33%, restricted closure in 44% and annular calcification in 7%. Regurgitant MR jet was eccentric in 49% of patients. For all patients, 3D VC area correlated significantly with EROA, better than 2D VC diameter (figure ). The advantage of 3D VC area over 2D VC diameter was more pronounced in eccentric jets (r=0.76, p< 0.001 vs. r=0.5, p =0.006, respectively) and in moderate to severe or severe MR (r=0.65, p<0.001 vs. r =0.13, p=0.54, respectively). Conclusions : Measurement of VC area is feasible with real-time 3D and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.

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Prognostic value of three dimensional-vena contracta area in patients with secondary mitral regurgitation

European Heart Journal ◽

10.1093/eurheartj/ehab724.1602 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

I Yedidya ◽

V Mantegazza ◽

F Namazi ◽

R Lustosa ◽

S C Butcher ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Color Doppler ◽

Three Dimensional ◽

Heart Failure Hospitalization ◽

Vena Contracta ◽

All Cause Mortality ◽

3D Color Doppler ◽

Vena Contracta Area

Abstract Background Effective regurgitant orifice area (EROA) is an important quantitative measurement for mitral regurgitation (MR) grading. Yet, the accuracy of this method is limited in patients with secondary mitral regurgitation (SMR). Three-dimensional (3D) color Doppler echocardiography allows for the direct assessment of the vena contracta area (VCA). The prognostic value of 3D-VCA in patients with secondary MR has not been investigated. Purpose The aim of the present study was to assess the association between 3D-VCA and prognosis of patients with SMR. Methods A total of 218 patients (69% men, median age 74 years) with significant SMR were retrospectively analyzed. 3D-VCA was measured offline with dedicated software, from restored 3D color Doppler full volume datasets of the mitral valve (Figure 1). The population was divided according to the American College of Cardiology expert recommendation for the grading of severe MR (VCA ≥50 mm2 and VCA <50 mm2). Patients were followed up for the combined end point of all-cause mortality or heart failure hospitalization. Results Of the total population, 63% had an ischemic etiology, 60% had atrial fibrillation and 25% cardiac resynchronization therapy. Patients with 3D-VCA ≥50 mm2 needed more diuretic therapy, had a larger left ventricle and atrium, and had more post-procedural residual MR. A total of 82% of patients underwent MitraClip device implantation, 17% had mitral valve repair and 1% had mitral valve replacement. During a median follow-up of 28 months, 130 (60%) met the combined end point (101 (46%) patients died and 81 (37%) were hospitalized due to heart failure). When dividing the population according to the cut-off of 3D-VCA, patients with a 3D-VCA≥50 mm2 had a worse prognosis compared with their counterparts (Figure 2). In a multivariable Cox regression analysis, 3D-VCA≥50 mm2 remained independently associated with the composite endpoint of all-cause mortality or heart failure hospitalization (HR=1.454, 95% CI 1.020–2.072, p=0.038). Conclusion In patients with SMR, a 3D-VCA ≥50 mm2 was independently associated with a combined endpoint of death or heart failure hospitalization. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Method of 3D-VCA measurement Figure 2. Kaplan-Meier survival curve

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