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

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. .

scholarly journals Concordance and Discordance of Echocardiographic Parameters Recommended for Assessing the Severity of Mitral Regurgitation

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Seth Uretsky ◽  
Lillian Aldaia ◽  
Leo Marcoff ◽  
Konstantinos Koulogiannis ◽  
Edgar Argulian ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Volume Index ◽  
Regurgitant Volume ◽  
Orifice Area ◽  
Vena Contracta ◽  
Echocardiographic Parameters ◽  
American Society ◽  
Regurgitant Orifice Area

Background: The American College of Cardiology/American Heart Association and American Society of Echocardiography guidelines recommend assessing several echocardiographic parameters when evaluating mitral regurgitation (MR) severity. These parameters can be discordant, making the assessment of MR challenging. The degree to which echocardiographic parameters of MR severity are concordant is not well studied. Methods: We enrolled 159 patients in a prospective multicenter study. Eight parameters were included in this analysis: proximal isovelocity surface area (PISA)–derived regurgitant volume, PISA-derived effective regurgitant orifice area, vena contracta, color Doppler jet/left atrial area, left atrial volume index, left ventricular end-diastolic volume index, peak E wave, and the presence of pulmonary vein systolic reversal. Each echocardiographic parameter was determined to represent severe or nonsevere MR according to the American Society of Echocardiography guidelines. A concordance score was calculated as so that a higher score reflects greater concordance. There was no discordance when all the echocardiographic parameters agreed and high discordance when 3 or 4 parameters were discordant. Results: The mean concordance score was 75±14% for the entire cohort. There were 9 (6%) patients with complete agreement of all parameters and 61 (38%) with high discordance. There was greater discordance in patients with severe MR but no difference between primary versus secondary or central versus eccentric jets. There was an improvement in concordance when only considering PISA-based regurgitant volume, PISA-based effective regurgitant orifice area, and vena contracta with agreement in 68% of patients. Conclusions: There was limited concordance between the echocardiographic parameters of MR severity, and the discordance was worse with more severe MR. Concordance improved when considering only 3 quantitative measures of vena contracta and PISA-based effective regurgitant orifice area and regurgitant volume. These findings highlight the challenges facing echocardiographers when assessing the severity of MR and emphasize the difficulty of using an integrated approach that incorporates multiple components. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04038879.

scholarly journals Does the volume overload exaggerate the severity of mitral regurgitation in patients with decompensated heart failure?

2020 ◽  
Vol 50 (6) ◽  
pp. 1552-1558
Author(s):  
Göktuğ SAVAŞ ◽  
Ömer ŞAHİN ◽  
Mustafa YAŞAN ◽  
Uğur KARABIYIK ◽  
Nihat KALAY ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Regurgitation ◽  
Volume Overload ◽  
Integrated Approach ◽  
Left Ventricular ◽  
Functional Mitral Regurgitation ◽  
Systolic Pulmonary Artery Pressure ◽  
Vena Contracta ◽  
Echocardiographic Parameters ◽  
Echocardiographic Assessment

Background/aim: Diagnosing and managing functional mitral regurgitation (MR) is often challenging and requires an integrated approach including a comprehensive echocardiographic examination. However, the effects of volume overload on the echocardiographic assessment of MR severity are uncertain. The purpose of this study was to weigh the effects of volume overload in the echocardiographic assessment of MR severity among patients with heart failure (HF).Materials and methods: Twenty-nine patients with decompensated HF, who had moderate or severe MR, were included in the present study. The volume status and the N-terminal pro-B-type natriuretic peptide (proBNP) levels were recorded and the echocardiographic parameters were assessed. After the conventional treatment for HF, the proBNP levels and the echocardiographic parameters were assessed again.Results: The mean age of the patients was 72 ± 9 years and the average hospitalization time was 10.9 ± 5.9 days. Between the beginning and the end of the treatment, there were significant reductions in the effective regurgitant orifice area (EROA) (0.36 ± 0.09 cm2 to 0.29 ± 0.09 cm2, P < 0.001), vena contracta (VC) (P < 0.001), the regurgitant volume (RV) (P < 0.001), and systolic pulmonary artery pressure (sPAP) (P < 0.001). Conclusion: This is the first study to investigate the relationship of changes in severity of MR with volume-load by monitoring the proBNP levels among patients with HF. The present results demonstrated that volume reduction, as evidenced by a decline in the proBNP levels, was accompanied by a marked reduction in the EROA, VC, and the RV among patients with left ventricular dysfunction.

Impact of Valve Surgery on Serum Osteopontin Levels in Patients with Mitral Regurgitation

Cardiology ◽  
2015 ◽  
Vol 130 (2) ◽  
pp. 82-86
Author(s):  
H.M. Gunes ◽  
G.B. Guler ◽  
E. Guler ◽  
G.G. Demir ◽  
S. Hatipoglu ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Lv Function ◽  
Vena Contracta ◽  
Atherosclerotic Lesions ◽  
Lv Dysfunction ◽  
Echocardiographic Parameters ◽  
Artery Disease ◽  
The Impact

Objective: Osteopontin (OPN), a sialoprotein present within atherosclerotic lesions, especially in calcified plaques, is linked to the progression of coronary artery disease and heart failure. We assessed the impact of valve surgery on serum OPN and left ventricular (LV) function in patients with mitral regurgitation (MR). Methods: Thirty-two patients with severe MR scheduled for surgery were included in the study. Echocardiography markers were assessed preoperatively and at 3 months following the surgery and matched with the serum OPN levels. Results: Valve surgery was associated with a reduction of the ejection fraction (EF) from 55.2 ± 6.3 to 48.8 ± 7.1% after surgery, p < 0.001. Following surgery, the OPN level was significantly higher than preoperatively (mean 245, range 36-2,284 ng/ml vs. 76, 6-486 ng/ml, p = 0.007). Preoperative OPN exhibited a slight negative correlation with the EF (r = -0.35, p = 0.04), and a moderate correlation with vena contracta (r = -0.38, p = 0.02). There were no other meaningful correlations between conventional echocardiographic parameters and OPN. Conclusion: Following valve surgery due to severe MR, patients exhibited a decrease in EF and an increase in OPN levels. The assessment of preoperative OPN failed to strongly predict probable LV dysfunction.

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.

scholarly journals 1637 Percutaneous treatment of severe tricuspid regurgitation in a "bicuspid" tricuspid valve

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Safi ◽  
T Pasala ◽  
A Shah ◽  
Y Dudiy ◽  
C Ruiz
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Color Doppler ◽  
Percutaneous Treatment ◽  
Left Ventricular ◽  
Severe Mitral Regurgitation ◽  
Severe Tricuspid Regurgitation ◽  
Severe Aortic Regurgitation

Abstract A 72 year old female with a past medical history of bicuspid aortic valve with severe aortic regurgitation status post placement of a 21 mm Magna Ease aortic valve replacement on 6/1/16, chronic atrial fibrillation, diabetes mellitus, and severe mitral regurgitation presented with symptoms of dyspnea upon exertion. Transesophageal echocardiogram (TEE) showed normal left ventricular function with severe mitral regurgitation, severe tricuspid regurgitation and severe pulmonary hypertension. Upon close interrogation of the tricuspid valve, there was evidence of fusion with a raphe present between the septal and anterior leaflets ("a bicuspid" tricuspid valve). The patient was referred for surgical evaluation where she was deemed to be at increased surgical risk and referred for percutaneous treatment for both severe mitral and severe tricuspid regurgitation. After an uncomplicated transseptal puncture, she underwent a placement of a single MitraClip XT clip to the A2/P2 portions of the mitral valve leaflets leaving mild residual mitral regurgitation by color Doppler. Attention was then taken towards the tricuspid valve where using TEE guidance, a MitraClip XT was positioned over the central aspect of the "bicuspid" tricuspid valve with the opened clip arms perpendicular leaflet coaptation. The MitraClip XT was advanced into the right ventricle and slowly retracted to grab both TV leaflets. There was mild, residual tricuspid regurgitation by color Doppler. The mean gradient across the tricuspid valve was 1 mmHg obtained at a heart rate of 52 bpm. This case describes the first known percutaneous treatment of severe tricuspid regurgitation from a "bicuspid" tricuspid valve with a MitraClip device. Abstract 1637 Figure.

scholarly journals P914 Changes of echocardiographic parameters in primary mitral regurgitation and determinants of symptom: an assessment from the Asian valve registry data

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Amano ◽  
C Izumi ◽  
Y J Kim ◽  
S J Park ◽  
S W Park ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Ejection Fraction ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Volume Index ◽  
P Value ◽  
Actual Measurement ◽  
Determinant Factors ◽  
Lv Mass ◽  
Echocardiographic Parameters

Abstract [Background]Clinicians often have a difficulty in determining the presence of mitral regurgitation (MR)-relatedsymptoms because of subjectivity.However, there are few actual measurement data for echocardiographic left ventricular (LV) and left atrial (LA) size related to the severity of MR and the relationship between MR-related symptoms and these echocardiographic parameters. [Purpose] The purpose of this study was to clarify actual values for echocardiographic parameters related to severity of MR and determinant factors of MR-related symptoms. [Methods] Among patients enrolled in the Asian Valve Registry, we investigated 778 consecutive patients with primary MR showing sinus rhythm. Symptoms were determined by NYHA (≤ II or ≥ III). [Results]MR severity was mild in 106, moderate in 285, and severe in 387 patients. LA volume index, LV end-diastolic diameter, and LV mass index increased with increasing MR grade [LA volume index: 47.9 (mild), 56.2 (moderate), and 64.9 ml/m2(severe) (p &lt; 0.001), LV end-diastolic diameter: 51.2, 54.5, 58.1 mm (p &lt; 0.001), and LV mass index: 101, 109, 123 g/m2(p &lt; 0.001)]. Regarding moderate and severe MR, 70 patients (10.4%) were symptomatic. Table shows multivariable analysis for being symptomatic in moderate and severe MR patients. LV mass index (p = 0.040), ejection fraction (p &lt; 0.001), female gender (p = 0.004), and heart rate (p = 0.007) were independent factors for MR-related symptoms. [Conclusions] LV and LA parameters on echocardiography worsened as MR severity progressed. Larger LV mass index and lower ejection fraction were independent determinant factors for MR-related symptoms. We should also pay attention to LV hypertrophy in patients with primary MR. Determinant factors for mitral regurgita Model 1 Model 2 OR (95% CI) P-value OR (95% CI) P-value Age, per 1-y increment 1.03 (1.00-1.05) 0.035 1.02 (0.99-1.05) 0.053 Sex (female) 2.23 (1.20-4.16) 0.011 2.28 (1.31-3.98) 0.004 Hear rate, per 1 bpm increment 1.03 (1.00-1.05) 0.025 1.03 (1.01-1.05) 0.007 LVDs index, per 1 mm increment 0.99 (0.90-1.09) 0.90 EF, per 1% increment 0.95 (0.92-0.99) 0.019 0.96 (0.93-0.98) &lt;0.001 LV mass index, per 10 g/m2increment 1.12 (1.01-1.25) 0.033 1.09 (1.005-1.18) 0.040 LA volume index, per 10 mL/m2increment 0.96 (0.90-1.03) 0.23 E wave, per 1cm/s increment 1.81 (0.70-4.66) 0.23 TR pressure gradient &gt;40 mmHg 2.11 (0.97-4.57) 0.057 Hypertention 1.40 (0.75-2.63) 0.29

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