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The International Journal of Cardiovascular Imaging

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01-02-2020 | Echocardiography | Original Paper

Quantification of mitral valve regurgitation by 2D and 3D echocardiography compared with cardiac magnetic resonance a systematic review and meta-analysis

Authors: Victor Sköldborg, Per Lav Madsen, Morten Dalsgaard, Jawdat Abdulla

Published in: The International Journal of Cardiovascular Imaging | Issue 2/2020

Abstract

By means of systematic literature review and meta-analysis, we compared results of studies examining different echocardiographic methods assessing severity of mitral valve regurgitation volume (MVR) with cardiac magnetic resonance imaging (CMR) as standard reference. A systematic search of electronic databases revealed twenty studies eligible for meta-analysis. Results of 2D- and 3D-trans-thoracic (TTE) and trans-esophageal echocardiographic (TEE) proximal isovelocity surface area (PISA) and volumetric methods were compared with CMR. Mean differences (ml) with 95% limits of agreement (LoA) derived from Bland–Altman tests and correlations coefficients [(R) 95% confidence interval (CI)] were pooled together. Overall 1187 patients [mean age = 59 ± 13 years and 678(57%) males] with primary or secondary mild to severe MVR were included. Comparing all echocardiographic methods with CMR showed an overestimation and moderate agreement with difference and 95% LoA of 8.05(− 3.40, 19.49) ml, R = 0.73(95% CI 0.71–0.76) p < 0.001. 3D-PISA followed by 3D-volumetric methods showed the better agreement with an underestimation of − 3.20(− 12.33, 5.92) ml, R = 0.84(95% CI 0.78–0.89) p < 0.001 and overestimation of 3.73(− 9.17, 16.61) ml, R = 0.90(95% CI 0.87, 0.94) p < 0.001, respectively. 2D-volumetric method showed the poorest agreement with difference and 95% LoA of 23.56(− 4.19, 51.31) ml, R = 0.64(95% CI 0.54–0.73) p < 0.001. In patients (n = 280) with severe MVR, 2D technique incorrectly estimated regurgitation volume severity in 106 (38%) compared to 4(14%) patients using 3D technique. Among echocardiographic methods 3D-PISA agreed best with CMR as reference, making 3D-PISA the most reliable method to quantify MVR. CMR can be considered in severe MVR where uncertainties arise and a decision-making prior valve surgery is required. Further powerful studies are needed to assess the accuracy of different echocardiographic methods.

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Title: Quantification of mitral valve regurgitation by 2D and 3D echocardiography compared with cardiac magnetic resonance a systematic review and meta-analysis
Authors: Victor Sköldborg
Per Lav Madsen
Morten Dalsgaard
Jawdat Abdulla
Publication date: 01-02-2020
Publisher: Springer Netherlands
Keywords: Echocardiography
Echocardiography
Published in: The International Journal of Cardiovascular Imaging / Issue 2/2020
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-019-01713-7

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