Differential Impact of Three-Dimensional Color Doppler Echocardiography for the Quantification of Mitral Regurgitation According to the Severity and Characteristics
Background—The aim of this study is to explore the differential impact of three-dimensional color Doppler echocardiography (3D-CDE) for the quantification of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography (2D-CDE) based MR quantification has well-documented limitations.
Methods and Results—We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-CDE in 211 patients (95.5%). The quantitative differences between the MR volumes obtained by 2D- and 3D-PISA were analyzed in various MR subgroups. In the validation cohort (N=52), MR volume obtained by 3D-PISA showed a better agreement with phase contrast cardiac magnetic resonance (PC-CMR) imaging than 2D-PISA (r= 0.97 vs. 0.84). In all 211 patients, 2D-PISA underestimated the MR volume compared to 3D-PISA (52.4 ± 19.6 vs. 59.5 ± 25.6 mL, p=0.005). 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having non-severe MR. In the subgroup analysis, the MR severity (OR: 6.96, 95%CI 3.04-15.94, p<0.001) and having an asymmetric orifice (OR: 11.48, 95%CI 3.72-35.4, p<0.001) and an eccentric jet (OR: 3.82, 95%CI, 1.27-11.48, p=0.017)were predictors of significant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods.
Conclusions—Quantification of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantification by 2D-PISA significantly underestimated MR volume with severe, eccentric MR with an asymmetric orifice. This paper demonstrates that 3D-CDE could be used as a valuable tool to confirm treatment strategy in patients with significant MR.
- Received November 21, 2013.
- Accepted March 27, 2014.