scholarly journals P1554 Assessment of functional mitral regurgitation with leg lift and exercise echocardiography using the average pixel intensity method

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
V Kamoen ◽  
M El Haddad ◽  
T De Backer ◽  
F Timmermans
Keyword(s):  
Mitral Regurgitation ◽  
Continuous Wave ◽  
Color Doppler ◽  
Significant Rise ◽  
Added Value ◽  
Functional Mitral Regurgitation ◽  
Exercise Echocardiography ◽  
Pixel Intensity ◽  
Vena Contracta ◽  
Average Pixel Intensity

Abstract Background Dynamic changes in functional mitral regurgitation (FMR) during exercise echocardiography were shown to be of prognostic value. However grading of FMR is challenging, especially during exercise echocardiography and therefore questioning its applicability in clinical practice. We recently introduced and validated the Average Pixel Intensity (API) for grading MR based on the pixel intensity of the continuous wave Doppler signal. In the current study we investigate the use of the API method using leg lift and exercise echocardiography in FMR. Methods We prospectively included 50 heart failure patients (mean ejection fraction 36%) in sinus rhythm with different grades of pure, FMR. After assessment of FMR severity at rest, the same acquisitions were repeated during leg lift and exercise echocardiography. FMR was assessed using the API method, color Doppler and quantitative grading methods (proximal isovelocity surface area (PISA) and vena contracta width (VCW)). Results The API method could be performed in all patients (100%) with leg lift (n = 50) and in 94% of the patients undergoing exercise echocardiography (n = 44), which was more than PISA and VCW (p < 0.001). During leg lift, there was a small but significant increase on visual color Doppler grading (grade 1.93 to 2.11 (p = 0.004); increase of FMR in 35% of patients, and no difference in 65%). For API, we found the same significant increase (93 to 101 au), however, API values showed increase of MR in 62% and decrease of FMR in 20%. During exercise echocardiography, we found no differences in color Doppler grade and API in the overall cohort (p 0.252 and p 0.832, respectively), despite 62% of patients showing some degree of increase in API during leg lift. On multivariate analysis, no specific echo parameter could be identified as independent predictor of API increase. Conclusions The novel API method is highly feasible for assessing dynamic FMR and may be of added value for in this setting, allowing the detection of even small increments of FMR severity. In the current study, we found only mild increases of FMR during exercise echocardiography. Leg lift testing however proved to be a simple and quick loading approach that induced a significant rise in FMR compared to exercise echocardiography. The prognostic relevance of the findings during leg lift remains to be determined.

Average pixel intensity method for prediction of outcome in secondary mitral regurgitation

Heart ◽  
2020 ◽  
Vol 106 (12) ◽  
pp. 904-909 ◽  
Author(s):  
Victor Kamoen ◽  
Marc De Buyzere ◽  
Milad El Haddad ◽  
Tine L M de Backer ◽  
Frank Timmermans
Keyword(s):  
Heart Failure ◽  
Clinical Outcome ◽  
Mitral Regurgitation ◽  
Continuous Wave ◽  
Independent Predictor ◽  
Multivariable Analysis ◽  
Systolic Heart Failure ◽  
Pixel Intensity ◽  
Secondary Mitral Regurgitation ◽  
Average Pixel Intensity

BackgroundEchocardiographic grading of secondary mitral regurgitation (SMR) severity is challenging and involves multiple guideline-recommended parameters. We previously introduced the average pixel intensity (API) method for grading SMR. In this study, the clinical outcome in SMR based on the API method for grading MR was compared with conventional grading methods.Methods231 patients with systolic heart failure and reduced ejection fraction (ischaemic/non-ischaemic) and SMR were prospectively enrolled. MR was graded using all guideline-recommended parameters and the API method, which is based on the pixel intensity of the continuous wave Doppler signal. The primary outcome was MACE (major adverse cardiac event).ResultsThe API method was applicable in 98% of patients with SMR (n=227). During a median follow-up of 24 months, 98 patients (43%) had a MACE (cardiovascular mortality (n=50, 22%), heart failure hospitalisation (n=44, 19%), mitral valve surgery (n=11, 5%), percutaneous mitral intervention (n=12, 5%), heart transplantation (n=5, 2%)). On log-rank test, the API method was highly significant in predicting clinical outcome. On multivariable Cox proportional hazard analysis, SMR grading with the API method was an independent predictor of clinical outcome (along with NYHA class and right ventricular systolic pressure; p<0.001), increasing the event risk by 9% per 10 au API rise (p=0.001). In the same multivariable analysis, proximal isovelocity surface area (PISA)-effective regurgitant orifice area or PISA-regurgitant volume were not independent predictors of events (p=0.18 and 0.26, respectively).ConclusionSMR grading with the API method is an independent predictor of clinical outcome and provides prognostic information in addition to clinical and other echocardiographic variables.

Insights into functional mitral regurgitation using the average pixel intensity method

2018 ◽  
Vol 35 (5) ◽  
pp. 761-769 ◽  
Author(s):  
Victor Kamoen ◽  
Milad El Haddad ◽  
Tine De Backer ◽  
Marc De Buyzere ◽  
Frank Timmermans
Keyword(s):  
Mitral Regurgitation ◽  
Functional Mitral Regurgitation ◽  
Pixel Intensity ◽  
Average Pixel Intensity

Outcome of degenerative nonprolapse mitral regurgitation using the average pixel intensity method

2020 ◽  
Vol 37 (9) ◽  
pp. 1329-1335
Author(s):  
Victor Kamoen ◽  
Milad El Haddad ◽  
Tine De Backer ◽  
Marc De Buyzere ◽  
Frank Timmermans
Keyword(s):  
Mitral Regurgitation ◽  
Pixel Intensity ◽  
Average Pixel Intensity

Grading of mitral regurgitation in mitral valve prolapse using the average pixel intensity method

2018 ◽  
Vol 258 ◽  
pp. 305-312 ◽  
Author(s):  
Victor Kamoen ◽  
Milad El Haddad ◽  
Marc De Buyzere ◽  
Tine De Backer ◽  
Frank Timmermans
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Prolapse ◽  
Pixel Intensity ◽  
Average Pixel Intensity

Abstract 12680: A Comparative Assessment of Echocardiographic Parameters for Determining Mitral Regurgitation Severity

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Seth Uretsky ◽  
Edgar Argulian ◽  
Leo Marcoff ◽  
Konstantinos Koulogiannis ◽  
Azhar Supariwala ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Linear Regression ◽  
Mitral Regurgitation ◽  
Color Doppler ◽  
Linear Regression Analysis ◽  
Integrated Approach ◽  
Multivariate Linear Regression Analysis ◽  
Moderate Correlation ◽  
Vena Contracta ◽  
Echocardiographic Parameters

Introduction: Guidelines suggest the use of several echocardiographic (Echo) parameters to assess mitral regurgitation (MR) severity using an integrated approach without guidance as how to weight each parameter. The aim of this study is to develop a hierarchy for Echo parameters of MR severity. Methods: This prospective study included 80 patients (63 ± 13 yrs, male 57%) with MR. Echo parameters including in this analysis were effective regurgitant orifice area (EROA), vena contracta (VC), LV EDD, color Doppler jet/LA area, the presence of a flail leaflet, and the presence of pulmonary vein wave systolic reversal. MR volume by MRI was calculated as the difference between the LV stroke volume and forward flow. A backward elimination multivariate linear regression analysis was used to determine which Echo parameters predicted regurgitant volume by MRI. Results: Individual Echo parameters that correlated best with MR volume by MRI were EROA (r = 0.68, p <0.0001), VC (r = 0.62, p < 0.0001), and the presence of a flail (r = 0.48, p < 0.0001) (figure 1). In the linear regression analysis, significant predictors of MR volume by MRI were EROA, VC and the presence of a flail with a moderate correlation with MR volume by MRI (overall model r = 0.72. p <0.0001). LV EDD, color Doppler jet/LA area, and the presence of reversal of the pulmonary systolic wave having no effect on the model. Of the 3 parameters in the model, EROA correlated the best with MR volume by MRI, followed by VC and the presence of a flail leaflet. Conclusions: Echocardiographic parameters for assessing MR had only a moderate correlation with MR volume by MRI. The model that best predicted MR volume by MRI included EROA, VC, and the presence of a flail leaflet. EROA was the best at predicting MR volume by MRI, followed by VC and the presence of a flail leaflet. Not all of the recommended echocardiographic measures of MR severity were helpful in predicting MR volume by MRI. .

Abstract 3382: Three-Dimensional Color Doppler Echocardiography for Direct Measurement of Mitral Regurgitation Vena Contracta Area: A Clinical Experience

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Stephen H Little ◽  
Rahul Kumar ◽  
Bahar Pirat ◽  
Marti L McCulloch ◽  
William A Zoghbi
Keyword(s):  
Mitral Regurgitation ◽  
Stroke Volume ◽  
Real Time ◽  
Direct Measurement ◽  
Color Doppler ◽  
Three Dimensional ◽  
Vena Contracta ◽  
Doppler Study ◽  
3D Color Doppler ◽  
Valve Pathology

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.

Overestimation of severity of ischemic/functional mitral regurgitation by color Doppler jet area

1994 ◽  
Vol 74 (8) ◽  
pp. 790-793 ◽  
Author(s):  
Robert B. McCully ◽  
Maurice Enriquez-Sarano ◽  
A.Jamil Tajik ◽  
James B. Seward
Keyword(s):  
Mitral Regurgitation ◽  
Color Doppler ◽  
Functional Mitral Regurgitation

P1777Concordance and discordance among the recommended echocardiographic parameters for the assessment of mitral regurgitation severity

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Uretsky ◽  
L Aldaia ◽  
L Marcoff ◽  
K Koulogiannis ◽  
M Rosenthal ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Color Doppler ◽  
Integrated Approach ◽  
Volume Index ◽  
Complete Agreement ◽  
Severe Mitral Regurgitation ◽  
Clinical Predictors ◽  
Entire Cohort ◽  
Vena Contracta ◽  
Echocardiographic Parameters

Abstract Background The EACVI and ACC/AHA guidelines recommend assessing several echocardiographic parameters when evaluating mitral regurgitant severity. In a given patient, these parameters can be discordant making the assessment of mitral regurgitation challenging. Purpose To assess the degree to which echocardiographic parameters of MR severity are concordant. Methods This analysis included 131 consecutive patients with primary mitral regurgitation enrolled in a prospective multicenter study. Nine parameters were included in this analysis (PISA –derived regurgitant volume, PISA-derived EROA, vena contracta, color Doppler jet/LA area, LA volume index, LVEDVI, peak E wave, pulmonary vein systolic flow reversal, and presence of flail leaflet). Each echocardiographic parameter was determined to represent severe or nonsevere mitral regurgitation according to the guidelines. A concordance score was calculated as: (the number of concordant parameters/9) * 100 so that a higher score reflects greater concordance. Each echocardiogram was graded as having mild, moderate, or severe mitral regurgitation using the guideline recommended integrated approach. Results The mean concordance score was 74±13% for the entire cohort. There were 4 (4%) patients with complete agreement of all parameters and 32 (25%) with agreement of 5 of the 9 parameters. There was greater discordance in patients with severe MR and eccentric jets but no difference between patients with prolapse or flail leaflets (Figure 1). Clinical predictors of discordance were vena contracta and the peak E wave. Figure 1 Conclusion In this series, there was imperfect concordance between the recommended echocardiographic parameters of MR severity in patients undergoing evaluation for mitral regurgitation. The discordance was worse with more severe mitral regurgitation and there was no ideal predictor of discordance. These findings highlight the challenges facing echocardiographers when assessing the severity of mitral regurgitation and underscore the importance of using the integrated approach recommended by professional societal guidelines. Acknowledgement/Funding None

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