Top

Published in:

Open Access 01-11-2021 | Echocardiography | Review

Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness

Authors: Andreas Hagendorff, Fabian Knebel, Andreas Helfen, Stephan Stöbe, Dariush Haghi, Tobias Ruf, Daniel Lavall, Jan Knierim, Ertunc Altiok, Roland Brandt, Nicolas Merke, Sebastian Ewen

Published in: Clinical Research in Cardiology | Issue 11/2021

Abstract

The echocardiographic assessment of mitral valve regurgitation (MR) by characterizing specific morphological features and grading its severity is still challenging. Analysis of MR etiology is necessary to clarify the underlying pathological mechanism of the valvular defect. Severity of mitral regurgitation is often quantified based on semi-quantitative parameters. However, incongruent findings and/or interpretations of regurgitation severity are frequently observed. This proposal seeks to offer practical support to overcome these obstacles by offering a standardized workflow, an easy means to identify non-severe mitral regurgitation, and by focusing on the quantitative approach with calculation of the individual regurgitant fraction. This work also indicates main methodological problems of semi-quantitative parameters when evaluating MR severity and offers appropriateness criteria for their use. It addresses the diagnostic importance of left-ventricular wall thickness, left-ventricular and left atrial volumes in relation to disease progression, and disease-related complaints to improve interpretation of echocardiographic findings. Finally, it highlights the conditions influencing the MR dynamics during echocardiographic examination. These considerations allow a reproducible, verifiable, and transparent in-depth echocardiographic evaluation of MR patients ensuring consistent haemodynamic plausibility of echocardiographic results.

Graphic abstract

Available only for authorised users

Wang A, Grayburn P, Foster JA, McCulloch ML, Badhwar V, Gammie JS, Costa SP, Benitez RM, Rinaldi MJ, Thourani VH, Martin RP (2016) Practice gaps in the care of mitral valve regurgitation: insights from the American College of Cardiology mitral regurgitation gap analysis and advisory panel. Am Heart J 172(2):70–79. https://doi.org/10.1016/j.ahj.2015.11.003CrossRefPubMed

Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL, European Association of Echocardiography (2010) European Association of Echocardiography recommendations for the assessment of valvular regurgitation Part 1 aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr 11(3):223–244. https://doi.org/10.1093/ejechocard/jeq030CrossRefPubMed

Lancellotti P, Tribouilloy C, Hagendorff A, Popescu BA, Edvardsen T, Pierard LA, Badano L, Zamorano JL, Scientific Document Committee of the European Association of Cardiovascular Imaging (2013) Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 14(7):611–644. https://doi.org/10.1093/ehjci/jet105CrossRefPubMed

Nickenig G, Mohr FM, Kelm M, Kuck KH, Boekstegers HJ, Schillinger W, Brachmann J, Lange R, Reichenspurner H (2013) Konsensus der Deutschen Gesellschaft für Kardiologie—Herz- und Kreislaufforschung und der Deutschen Gesellschaft für Thorax-Herz- und Gefäßchirurgie zur Behandlung der Mitralklappeninsuffizienz. Kardiologe 7:76–90. https://doi.org/10.1007/s12181-013-0488-1CrossRef

Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, Hahn RT, Han Y, Hung J, Lang RM, Little SH, Shah DJ, Shernan S, Thavendiranathan P, Thomas JD, Weissman NJ (2017) Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance. J Am Soc Echocardiogr 30(4):303–371. https://doi.org/10.1016/j.echo.2017.01.007CrossRefPubMed

Bonow RO, O’Gara PT, Adams DH, Badhwar V, Bavaria JE, Elmariah S, Hung JW, Lindenfeld J, Morris AA, Satpathy R, Whisenant B, Woo YJ (2020) 2020 focused update of the 2017 ACC expert consensus decision pathway on the management of mitral regurgitation: a report of the American College of Cardiology solution set oversight committee. J Am Coll Cardiol 75(17):2236–2270. https://doi.org/10.1016/j.jacc.2020.02.005CrossRefPubMed

Hagendorff A, Fehske W, Flachskampf FA, Helfen A, Kreidel F, Kruck S, La Rosée K, Tiemann K, Voigt JU, von Bardeleben RS, Ralf Zahn R, Fabian Knebel F (2020) Manual zur Indikation und Durchführung der Echokardiographie—update 2020 der Deutschen Gesellschaft für Kardiologie. Kardiologe 14:396–431. https://doi.org/10.1007/s12181-020-00402-3CrossRef

Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, Schofer J, Cutlip DE, Krucoff MW, Blackstone EH, Généreux P, Mack MJ, Siegel RJ, Grayburn PA, Enriquez-Sarano M, Lancellotti P, Filippatos G, Kappetein AP (2015) Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 1: clinical trial design principles: a consensus document from the mitral valve academic research consortium. J Am Coll Cardiol 66(3):278–307. https://doi.org/10.1016/j.jacc.2015.05.046CrossRefPubMed

Stone GW, Adams DH, Abraham WT, Kappetein AP, Généreux P, Vranckx P, Mehran R, Kuck KH, Leon MB, Piazza N, Head SJ, Filippatos G, Vahanian AS (2015) Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: Part 2: endpoint definitions: a consensus document from the mitral valve academic research consortium. J Am Coll Cardiol 66(3):308–321. https://doi.org/10.1016/j.jacc.2015.05.049CrossRefPubMed

10.

Stone GW, Lindenfeld J, Abraham WT, Kar S, Lim DS, Mishell JM, Whisenant B, Grayburn PA, Rinaldi M, Kapadia SR, Rajagopal V, Sarembock IJ, Brieke A, Marx SO, Cohen DJ, Weissman NJ, Mack MJ, Investigators COAPT (2018) Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med 379(24):2307–2318. https://doi.org/10.1056/NEJMoa1806640CrossRefPubMed

11.

Asch AF, Grayburn PA, Siegel RJ, Kar S, Lim DS, Zaroff JG, Mishell JM, Whisenant B, Mack MJ, JoAnn Lindenfeld JA, Abraham WT, Stone GW, Weissman NJ (2019) Echocardiographic outcomes after transcatheter leaflet approximation in patients with secondary mitral regurgitation: the COAPT trial. J Am Coll Cardiol. 74(24):2969–2979. https://doi.org/10.1016/j.jacc.2019.09.017CrossRefPubMed

12.

Recusani F, Bargiggia GS, Yoganathan AP, Raisaro A, Valdes-Cruz LM, Sung HW, Bertucci C, Gallati M, Moises VA, Simpson IA, Tronconi L, Sahn DJ (1991) A new method for quantification of regurgitant flow rate using color Doppler flow imaging of the flow convergence region proximal to a discrete orifice. An in vitro study. Circulation 83(2):594–604. https://doi.org/10.1161/01.cir.83.2.594CrossRefPubMed

13.

Grayburn PA, Weissman NJ, Zamorano JL (2012) Quantitation of mitral regurgitation. Circulation 126(16):2005–2017. https://doi.org/10.1161/CIRCULATIONAHA.112.121590CrossRefPubMed

14.

Simpson IA, Shiota T, Gharib M, Sahn DJ (1996) Current status of flow convergence for clinical applications: is it a leaning tower of “PISA”? J Am Coll Cardiol 27(2):504–509. https://doi.org/10.1016/0735-1097(95)00486-6CrossRefPubMed

15.

Yosefy C, Levine RA, Solis J, Vaturi M, Handschumacher MD, Hung J (2007) Proximal flow convergence region as assessed by real-time 3-dimensional echocardiography: challenging the hemispheric assumption. J Am Soc Echocardiogr 20(4):389–396. https://doi.org/10.1016/j.echo.2006.09.006CrossRefPubMed

16.

Grayburn PA, Carabello B, Hung J, Gillam LD, Liang D, Mack MJ, McCarthy PM, Miller DC, Trento A, Siegel RJ (2014) Defining “severe” secondary mitral regurgitation: emphasizing an integrated approach. J Am Coll Cardiol 64(25):2792–2801. https://doi.org/10.1016/j.jacc.2014.10.016CrossRefPubMed

17.

Quéré JP, Tribouilloy C, Enriquez-Sarano M (2003) Vena contract measurement: theoretic basis and usefulness in the assessment of valvular regurgitation severity. Curr Cardiol Rep 5(2):110–115. https://doi.org/10.1007/s11886-003-0077-1CrossRefPubMed

18.

Biner S, Rafique A, Rafii F, Tolstrup K, Noorani O, Shiota T, Gurudevan S, Siegel RJ (2010) Reproducibility of proximal isovelocity surface area, vena contracta, and regurgitant jet area for assessment of mitral regurgitation severity. JACC Cardiovasc Imaging 3(3):235–243. https://doi.org/10.1016/j.jcmg.2009.09.029CrossRefPubMed

19.

Uretsky S, Aldaia L, Marcoff L, Koulogiannis K, Argulian E, Lasam G, Gillam L (2020) Concordance and discordance of echocardiographic parameters recommended for assessing the severity of mitral regurgitation. Circ Cardiovasc Imaging 13(5):e010278. https://doi.org/10.1161/CIRCIMAGING.119.010278 (Epub 2020)CrossRefPubMed

20.

Schwammenthal E, Chen C, Benning F, Block M, Breithardt G, Levine RA (1994) Dynamics of mitral regurgitant flow and orifice area. Physiologic application of the proximal flow convergence method: clinical data and experimental testing. Circulation 90(1):307–322. https://doi.org/10.1161/01.cir.90.1.307CrossRefPubMed

21.

Hung J, Otsuji Y, Handschumacher MD, Schwammenthal E, Levine RA (1999) Mechanism of dynamic regurgitant orifice area variation in functional mitral regurgitation: physiologic insights from the proximal flow convergence technique. J Am Coll Cardiol 33(2):538–545. https://doi.org/10.1016/s0735-1097(98)00570-1CrossRefPubMed

22.

Buck T, Plicht B, Kahlert P, Schenk IM, Hunold P, Erbel R (2008) Effect of dynamic flow rate and orifice area on mitral regurgitant stroke volume quantification using the proximal isovelocity surface area method. J Am Coll Cardiol 52(9):767–778. https://doi.org/10.1016/j.jacc.2008.05.028CrossRefPubMed

23.

Watanabe N (2019) Acute mitral regurgitation. Heart 105(9):671–677. https://doi.org/10.1136/heartjnl-2018-313373CrossRefPubMed

24.

Altiok E, Hamada S, van Hall S, Hanenberg M, Dohmen G, Almalla M, Grabskaya E, Becker M, Marx N, Hoffmann R (2011) Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by color Doppler echocardiography. Am J Cardiol 107(3):452–458. https://doi.org/10.1016/j.amjcard.2010.09.043CrossRefPubMed

25.

Chandra S, Salgo IS, Sugeng L, Weinert L, Settlemier SH, Mor-Avi V, Lang RM (2011) A three-dimensional insight into the complexity of flow convergence in mitral regurgitation: adjunctive benefit of anatomic regurgitant orifice area. Am J Physiol Heart Circ Physiol 301(3):H1015–H1024. https://doi.org/10.1152/ajpheart.00275.2011CrossRefPubMedPubMedCentral

26.

Zeng X, Levine RA, Hua L, Morris EL, Kang Y, Flaherty M, Morgan NV, Hung J (2011) Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color Doppler 3D echocardiography. Circ Cardiovasc Imaging 4(5):506–513. https://doi.org/10.1161/CIRCIMAGING.110.961649CrossRefPubMedPubMedCentral

27.

Enriquez-Sarano M, Dujardin KS, Tribouilloy CM, Seward JB, Yoganathan AP, Bailey KR, Tajik AJ (1999) Determinants of pulmonary venous flow reversal in mitral regurgitation and its usefulness in determining the severity of regurgitation. Am J Cardiol 83(4):535–541. https://doi.org/10.1016/s0002-9149(98)00909-6CrossRefPubMed

28.

Tribouilloy C, Shen WF, Rey JL, Adam MC, Lesbre JP (1994) Mitral to aortic velocity-time integral ratio. A non-geometric pulsed-Doppler regurgitant index in isolated pure mitral regurgitation. Eur Heart J 15(10):1335–1339. https://doi.org/10.1093/oxfordjournals.eurheartj.a060390CrossRefPubMed

29.

Carabello BA (2008) The current therapy for mitral regurgitation. J Am Coll Cardiol 52(5):319–326. https://doi.org/10.1016/j.jacc.2008.02.084CrossRefPubMed

30.

Bennett S, Thamman R, Griffiths T, Oxley C, Khan JN, Phan T, Patwala A, Heatlie G, Kwok CS (2019) Mitral annular disjunction: a systematic review of the literature. Echocardiography 36(8):1549–1558. https://doi.org/10.1111/echo.14437CrossRefPubMed

31.

Dziadzko V, Dziadzko M, Medina-Inojosa JR, Benfari G, Michelena HI, Crestanello JA, Maalouf J, Thapa P, Enriquez-Sarano M (2019) Causes and mechanisms of isolated mitral regurgitation in the community: clinical context and outcome. Eur Heart J 40(27):2194–2202. https://doi.org/10.1093/eurheartj/ehz314CrossRefPubMed

32.

Carpentier A (1983) Cardiac valve surgery—the “French correction.” J Thorac Cardiovasc Surg 86(3):323–337CrossRef

33.

Enriquez-Sarano M, Akins CW, Vahanian A (2009) Mitral regurgitation. Lancet 373:1382–1394. https://doi.org/10.1016/S0140-6736(09)60692-9CrossRefPubMed

34.

Deferm S, Bertrand PB, Verbrugge FH et al (2019) Atrial functional mitral regurgitation: JACC review topic of the week. J Am Coll Cardiol 73:2465–2476. https://doi.org/10.1016/j.jacc.2019.02.061CrossRefPubMed

35.

Opie LH, Commerford PJ, Gersh BJ, Pfeffer MA (2006) Controversies in ventricular remodelling. Lancet 367:356–367. https://doi.org/10.1016/S0140-6736(06)68074-4CrossRefPubMed

36.

Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Munoz DR, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791. https://doi.org/10.1093/eurheartj/ehx391CrossRefPubMed

37.

Lavall D, Reil JC, Segura Schmitz L et al (2016) Early hemodynamic improvement after percutaneous mitral valve repair evaluated by noninvasive pressure-volume analysis. J Am Soc Echocardiogr 29:888–898. https://doi.org/10.1016/j.echo.2016.05.012CrossRefPubMed

38.

Kamperidis V, Marsan NA, Delgado V, Bax JJ (2016) Left ventricular systolic function assessment in secondary mitral regurgitation: Left ventricular ejection fraction vs. speckle tracking global longitudinal strain. Eur Heart J 37:811–816. https://doi.org/10.1093/eurheartj/ehv680CrossRefPubMed

39.

Gaasch WH, Aurigemma GP, Meyer TE (2020) An appraisal of the association of clinical outcomes with the severity of regurgitant volume relative to end-diastolic volume in patients with secondary mitral regurgitation. JAMA Cardiol 5:476–481. https://doi.org/10.1001/jamacardio.2019.5980CrossRefPubMed

40.

Packer M, Grayburn PA (2020) New evidence supporting a novel conceptual framework for distinguishing proportionate and disproportionate functional mitral regurgitation. JAMA Cardiol. https://doi.org/10.1001/jamacardio.2019.5971CrossRefPubMedPubMedCentral

41.

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014CrossRef

42.

Abramowitz Y, Jilaihawi H, Chakravarty T, Mack MJ, Makkar RR (2015) Mitral annulus calcification. J Am Coll Cardiol 66(17):1934–1941. https://doi.org/10.1016/j.jacc.2015.08.872CrossRefPubMed

43.

De Castro S, Caselli S, Maron M, Pelliccia A, Cavarretta E, Maddukuri P, Cartoni D, Di Angelantonio E, Kuvin JT, Patel AR, Pandian NG (2007) Left ventricular remodelling index (LVRI) in various pathophysiological conditions: a real-time three-dimensional echocardiographic study. Heart 93(2):205–209. https://doi.org/10.1136/hrt.2006.093997CrossRefPubMed

44.

Kono T, Sabbah HN, Stein PD, Brymer JF, Khaja F (1991) Left ventricular shape as a determinant of functional mitral regurgitation in patients with severe heart failure secondary to either coronary artery disease or idiopathic dilated cardiomyopathy. Am J Cardiol 68(4):355–359. https://doi.org/10.1016/0002-9149(91)90831-5CrossRefPubMed

45.

Yiu SF, Enriquez-Sarano M, Tribouilloy C, Seward JB, Tajik AJ (2000) Determinants of the degree of functional mitral regurgitation in patients with systolic left ventricular dysfunction: a quantitative clinical study. Circulation 102(12):1400–1406. https://doi.org/10.1161/01.cir.102.12.1400CrossRefPubMed

46.

Balachandran P, Schaff HV, Lahr BD, Nguyen A, Daly RC, Maltais S, Pislaru SV, Dearani JA (2020) Preoperative left atrial volume index is associated with postoperative outcomes in mitral valve repair for chronic mitral regurgitation. J Thorac Cardiovasc Surg 160(3):661-672.e5. https://doi.org/10.1016/j.jtcvs.2019.08.040CrossRefPubMed

47.

Kou S, Caballero L, Dulgheru R, Voilliot D, De Sousa C, Kacharava G, Athanassopoulos GD, Barone D, Baroni M, Cardim N, Gomez De Diego JJ, Hagendorff A, Henri C, Hristova K, Lopez T, Magne J, De La Morena G, Popescu BA, Penicka M, Ozyigit T, Rodrigo Carbonero JD, Salustri A, Van De Veire N, Von Bardeleben RS, Vinereanu D, Voigt JU, Zamorano JL, Donal E, Lang RM, Badano LP, Lancellotti P (2014) Echocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study. Eur Heart J Cardiovasc Imaging 15(6):680–690. https://doi.org/10.1093/ehjci/jet284CrossRefPubMedPubMedCentral

48.

Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA (2012) EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 13(1):1–46. https://doi.org/10.1093/ehjci/jer316CrossRefPubMed

49.

Magne J, Pibarot P, Dagenais F, Hachicha Z, Dumesnil JG, Senechal M (2007) Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation. Circulation 115(6):782–791. https://doi.org/10.1161/CIRCULATIONAHA.106.649236CrossRefPubMed

50.

Gelsomino S, van Garsse L, Lucà F, Lorusso R, Cheriex E, Rao CM, Caciolli S, Vizzardi E, Crudeli E, Stefàno P, Gensini GF, Maessen J (2011) Impact of preoperative anterior leaflet tethering on the recurrence of ischemic mitral regurgitation and the lack of left ventricular reverse remodeling after restrictive annuloplasty. J Am Soc Echocardiogr 24(12):1365–1375. https://doi.org/10.1016/j.echo.2011.09.015CrossRefPubMed

51.

Shakil O, Jainandunsing JS, Ilic R, Matyal R, Mahmood F (2013) Ischemic mitral regurgitation: an intraoperative echocardiographic perspective. J Cardiothorac Vasc Anesth 27(3):573–585. https://doi.org/10.1053/j.jvca.2012.06.003CrossRefPubMed

52.

Pepi M, Tamborini G, Maltagliati A, Galli CA, Sisillo E, Salvi L, Naliato M, Porqueddu M, Parolari A, Zanobini M, Alamanni F (2006) Head-to-head comparison of two- and three-dimensional transthoracic and transesophageal echocardiography in the localization of mitral valve prolapse. J Am Coll Cardiol 48(12):2524–2530. https://doi.org/10.1016/j.jacc.2006.02.079CrossRefPubMed

53.

Thompson KA, Shiota T, Tolstrup K, Gurudevan SV, Siegel RJ (2011) Utility of three-dimensional transesophageal echocardiography in the diagnosis of valvular perforations. Am J Cardiol 107(1):100–102. https://doi.org/10.1016/j.amjcard.2010.08.051CrossRefPubMed

54.

Lee AP, Hsiung MC, Salgo IS, Fang F, Xie JM, Zhang YC, Lin QS, Looi JL, Wan S, Wong RH, Underwood MJ, Sun JP, Yin WH, Wei J, Tsai SK, Yu CM (2013) Quantitative analysis of mitral valve morphology in mitral valve prolapse with real-time 3-dimensional echocardiography: importance of annular saddle shape in the pathogenesis of mitral regurgitation. Circulation 127(7):832–841. https://doi.org/10.1161/CIRCULATIONAHA.112.118083CrossRefPubMed

55.

Narang A, Addetia K, Weinert L, Yamat M, Shah AP, Blair JE, Mor-Avi V, Lang RM (2018) Diagnosis of isolated cleft mitral valve using three-dimensional echocardioraphy. J Am Soc Echocardiogr 31(11):1161–1167. https://doi.org/10.1016/j.echo.2018.06.008CrossRefPubMedPubMedCentral

56.

De Castro S, Cartoni D, d’Amati G, Beni S, Yao J, Fiorell M, Gallo P, Fedele F, Pandian NG (2000) Diagnostic accuracy of transthoracic and multiplane transesophageal echocardiography for valvular perforation in acute infective endocarditis: correlation with anatomic findings. Clin Infect Dis 30(5):825–826. https://doi.org/10.1086/313762CrossRefPubMed

57.

Dwivedi G, Mahadevan G, Jimenez D, Frenneaux M, Steeds RP (2014) Reference values for mitral and tricuspid annular dimensions using two-dimensional echocardiography. Echo Res Pract 1(2):43–50. https://doi.org/10.1530/ERP-14-0050CrossRefPubMedPubMedCentral

58.

Obadia JF, Messika-Zeitoun D, Leurent G, Iung B, Bonnet G, Piriou N, Lefèvre T, Piot C, Rouleau F, Carrié D, Nejjari M, Ohlmann P, Leclercq F, Saint Etienne C, Teiger E, Leroux L, Karam N, Michel N, Gilard M, Donal E, Trochu JN, Cormier B, Armoiry X, Boutitie F, Maucort-Boulch D, Barnel C, Samson G, Guerin P, Vahanian A, Mewton N, Investigators MITRA-FR (2018) Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med 379(24):2297–2306. https://doi.org/10.1056/NEJMoa1805374CrossRefPubMed

59.

Witte KK, Lipiecki J, Siminiak T, Meredith IT, Malkin CJ, Goldberg SL, Stark MA, von Bardeleben RS, Cremer PC, Jaber WA, Celermajer DS, Kaye DM, Sievert H (2019) REDUCE FMR trial: a randomized sham-controlled study of percutaneous mitral annuloplasty in functional mitral regurgitation. JACC Heart Fail 7:945–955. https://doi.org/10.1016/j.jchf.2019.06.011CrossRefPubMed

60.

Namazi F, van der Bijl P, Fortuni F, Mertens BJA, Kamperidis V, van Wijngaarden SE, Stone GW, Narula J, Ajmone Marsan N, Vahanian A, Delgado V, Bax JJ (2020) Regurgitant volume/left ventricular end-diastolic volume ratio: prognostic value in patients with secondary mitral regurgitation. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2020.06.032CrossRefPubMed

61.

Arias T, Chen J, Fayad ZA, Fuster V, Hajjar RJ, Chemaly ER (2013) Comparison of echocardiographic measurements of left ventricular volumes to full volume magnetic resonance imaging in normal and diseased rats. J Am Soc Echocardiogr 26(8):910–918. https://doi.org/10.1016/j.echo.2013.04.016CrossRefPubMedPubMedCentral

62.

Holt JP, Rhode EA, Kines H (1968) Ventricular volumes and body weight in mammals. Am J Physiol 215(3):704–715. https://doi.org/10.1152/ajplegacy.1968.215.3.704CrossRefPubMed

63.

Rigolli M, Anandabaskaran S, Christiansen JP, Whalley GA (2016) Bias associated with left ventricular quantification by multimodality imaging: a systematic review and meta-analysis. Open Heart 3(1):388. https://doi.org/10.1136/openhrt-2015-000388 (eCollection 2016)CrossRef

64.

Moceri P, Doyen D, Bertora D, Cerboni P, Ferrari E, Gibelin P (2012) Real time three-dimensional echocardiographic assessment of left ventricular function in heart failure patients: underestimation of left ventricular volume increases with the degree of dilatation. Echocardiography 29(8):970–977. https://doi.org/10.1111/j.1540-8175.2012.01707.xCrossRefPubMed

65.

Mårtensson M, Winter R, Cederlund K, Ripsweden J, Mir-Akbari H, Nowak J, Brodin LA (2008) Assessment of left ventricular volumes using simplified 3-D echocardiography and computed tomography—a phantom and clinical study. Cardiovasc Ultrasound. https://doi.org/10.1186/1476-7120-6-26CrossRefPubMedPubMedCentral

66.

Aurich M, André F, Keller M, Greiner S, Hess A, Buss SJ, Katus HA, Mereles D (2014) Assessment of left ventricular volumes with echocardiography and cardiac magnetic resonance imaging: real-life evaluation of standard versus new semiautomatic methods. J Am Soc Echocardiogr 27(10):1017–1024. https://doi.org/10.1016/j.echo.2014.07.006CrossRefPubMed

67.

Hagendorff A, Doenst T, Falk V (2019) Echocardiographic assessment of functional mitral regurgitation: opening Pandora’s box? ESC Heart Fail 6(4):678–685. https://doi.org/10.1002/ehf2.12491CrossRefPubMedPubMedCentral

68.

Hagendorff A, Knebel F, Helfen A, Stöbe S, Doenst T, Falk V (2020) Disproportionate mitral regurgitation: another myth? A critical appraisal of echocardiographic assessment of functional mitral regurgitation. Int J Cardiovasc Imaging. https://doi.org/10.1007/s10554-020-01975-6CrossRefPubMedPubMedCentral

69.

Kamoen V, Calle S, De Buyzere M, Timmermans F (2020) Proportionate or disproportionate secondary mitral regurgitation: how to untangle the Gordian knot? Heart 106(22):1719–1725. https://doi.org/10.1136/heartjnl-2020-317040CrossRefPubMed

70.

Stöbe S, Kreyer K, Jurisch D, Pfeiffer D, Lavall D, Farese G, Laufs U, Hagendorff A (2020) Echocardiographic analysis of acute effects of percutaneous mitral annuloplasty on severity of functional mitral regurgitation. ESC Heart Fail 7(4):1645–1652. https://doi.org/10.1002/ehf2.12719CrossRefPubMedPubMedCentral

71.

Malm S, Frigstad S, Sagberg E, Larsson H, Skjaerpe T (2004) Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging. J Am Coll Cardiol 44(5):1030–1035. https://doi.org/10.1016/j.jacc.2004.05.068CrossRefPubMed

72.

Jenkins C, Moir S, Chan J, Rakhit D, Haluska B, Marwick TH (2009) Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both wit magnetic resonance imaging. Eur Heart J 30(1):98–106. https://doi.org/10.1093/eurheartj/ehn484CrossRefPubMed

73.

Grayburn PA, Sannino A, Packer M (2019) Proportionate and disproportionate functional mitral regurgitation: a new conceptual framework that reconciles the results of the MITRA-FR and COAPT trials. JACC Cardiovasc Imaging 12(2):353–362. https://doi.org/10.1016/j.jcmg.2018.11.006CrossRefPubMed

74.

Hahn RT (2020) Disproportionate emphasis on proportionate mitral regurgitation-are there better measures of regurgitant severity? JAMA Cardiol. https://doi.org/10.1001/jamacardio.2019.6235CrossRefPubMed

75.

Packer M (2020) Disproportionate functional mitral regurgitation: a new therapeutic target in patients with heart failure and a reduced ejection fraction. Eur J Heart Fail 22(1):23–25. https://doi.org/10.1002/ejhf.1469CrossRefPubMed

76.

Hagendorff A, Knebel F, Helfen A, Knierim J, Sinning C, Stöbe S, Fehske W, Ewen S (2020) Expert consensus document on the assessment of the severity of aortic valve stenosis by echocardiography to provide diagnostic conclusiveness by standardized verifiable documentation. Clin Res Cardiol 109(3):271–288. https://doi.org/10.1007/s00392-019-01539-2CrossRefPubMed

77.

Izumo M, Lancellotti P, Suzuki K, Kou S, Shimozato T, Hayashi A, Akashi YJ, Osada N, Omiya K, Nobuoka S, Ohtaki E, Miyake F (2009) Three-dimensional echocardiographic assessments of exercise-induced changes in left ventricular shape and dyssynchrony in patients with dynamic functional mitral regurgitation. Eur J Echocardiogr 10(8):961–967. https://doi.org/10.1093/ejechocard/jep114CrossRefPubMed

78.

Bertrand PB, Schwammenthal E, Levine RA, Vandervoort PM (2017) Exercise dynamics in secondary mitral regurgitation: pathophysiology and therapeutic implications. Circulation 135(3):297–314. https://doi.org/10.1161/CIRCULATIONAHA.116.025260CrossRefPubMedPubMedCentral

Title: Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness
Authors: Andreas Hagendorff
Fabian Knebel
Andreas Helfen
Stephan Stöbe
Dariush Haghi
Tobias Ruf
Daniel Lavall
Jan Knierim
Ertunc Altiok
Roland Brandt
Nicolas Merke
Sebastian Ewen
Publication date: 01-11-2021
Publisher: Springer Berlin Heidelberg
Keywords: Echocardiography
Echocardiography
Published in: Clinical Research in Cardiology / Issue 11/2021
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-021-01841-y

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness

Abstract

Graphic abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Graphic abstract

Please log in to get access to this content

Other articles of this Issue 11/2021

Short- and long-term outcome of patients with spontaneous echo contrast or thrombus in the left atrial appendage in the era of the direct acting anticoagulants

Echocardiographic diagnosis of atrial cardiomyopathy allows outcome prediction following pulmonary vein isolation

Biopsy-proven lymphocytic myocarditis following first mRNA COVID-19 vaccination in a 40-year-old male: case report

SARS-CoV-2, myocardial injury and inflammation: insights from a large clinical and autopsy study

Clinical and cardiac magnetic resonance findings in post-COVID patients referred for suspected myocarditis

Prognostic value of the chest X-ray in patients hospitalised for heart failure

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page