Top

The International Journal of Cardiovascular Imaging

Published in:

01-02-2013 | Original Paper

Quantification of mitral valve regurgitation with color flow Doppler using baseline shift

Authors: Hannah Heß, Sarah Eibel, Chirojit Mukherjee, Udo X. Kaisers, Joerg Ender

Published in: The International Journal of Cardiovascular Imaging | Issue 2/2013

Abstract

Vena contracta width (VCW) and effective regurgitant orifice area (EROA) are well established methods for evaluating mitral regurgitation using transesophageal echocardiography (TEE). For color-flow Doppler (CF) measurements Nyquist limit of 50–60 cm/s is recommended. Aim of the study was to investigate the effectiveness of a baseline shift of the Nyquist limit for these measurements. After a comprehensive 2-dimensional (2D) TEE examination, the mitral regurgitation jet was acquired with a Nyquist limit of 50 cm/s (NL50) along with a baseline shift to 37.5 cm/s (NL37.5) using CF. Moreover a real time 3-dimensional (RT 3D) color complete volume dataset was stored with a Nyquist limit of 50 cm/s (NL50) and 37.5 cm/s (NL37.5). Vena contracta width (VCW) as well as Proximal Isovelocity Surface Area (PISA) derived EROA were measured based on 2D TEE and compared to RT 3D echo measurements for vena contracta area (VCA) using planimetry method. Correlation between VCA 3D NL50 and VCW NL50 was 0.29 (p < 0.05) compared to 0.6 (p < 0.05) using NL37.5. Correlation between VCA 3D NL50 and EROA 2D NL50 was 0.46 (p < 0.05) vs. 0.6 (p < 0.05) EROA 2D NL37.5. Correlation between VCA 3D NL37.5 and VCW NL50 was 0.45 (p < 0.05) compared to 0.65 (p < 0.05) using VCW NL37.5. Correlation between VCA 3D NL37.5 and EROA 2D NL50 was 0.41 (p < 0.05) vs. 0.53 (p < 0.05) using EROA 2D NL37.5. Baseline shift of the NL to 37.5 cm/s improves the correlation for VCW and EROA when compared to RT 3D NL50 planimetry of the vena contracta area. Baseline shift in RT 3D to a NL of 37.5 cm/s shows similar results like NL50.

Enriquez-Sarano M, Sundt TM III (2010) Early surgery is recommended for mitral regurgitation. Circulation 121:804–811PubMedCrossRef

Bonow RO, Carabello BA, Chatterjee K et al (2008) 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52:e1–e142PubMedCrossRef

Fehske W, Omran H, Manz M et al (1994) Color-coded Doppler imaging of the vena contracta as a basis for quantification of pure mitral regurgitation. Am J Cardiol 73:268–274PubMedCrossRef

Hall SA, Brickner ME, Willett DL et al (1997) Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. Circulation 95:636–642PubMedCrossRef

Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16:777–802PubMedCrossRef

Schwammenthal E, Chen C, Benning F et al (1994) Dynamics of mitral regurgitant flow and orifice area. Physiologic application of the proximal flow convergence method: clinical data and experimental testing. Circulation 90:307–322PubMedCrossRef

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 27:504–509PubMedCrossRef

Kahlert P, Plicht B, Schenk IM et al (2008) Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography. J Am Soc Echocardiogr 21:912–921PubMedCrossRef

Veronesi F, Corsi C, Sugeng L et al (2008) Quantification of mitral apparatus dynamics in functional and ischemic mitral regurgitation using real-time 3-dimensional echocardiography. J Am Soc Echocardiogr 21:347–354PubMedCrossRef

10.

Sugeng L, Chandra S, Lang RM (2009) Three-dimensional echocardiography for assessment of mitral valve regurgitation. Curr Opin Cardiol 24:420–425PubMedCrossRef

11.

Altiok E, Hamada S, van HS et al (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 107:452–458PubMedCrossRef

12.

Shanewise JS, Cheung AT, Aronson S et al (1999) ASE/SCA guidelines for performing a comprehensive intraoperative multiplane transesophageal echocardiography examination: recommendations of the American Society of Echocardiography Council for Intraoperative Echocardiography and the Society of Cardiovascular Anesthesiologists Task Force for Certification in Perioperative Transesophageal Echocardiography. Anesth Analg 89:870–884PubMed

13.

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

14.

Grigioni F, Enriquez-Sarano M, Zehr KJ et al (2001) Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation 103:1759–1764PubMedCrossRef

15.

Zeng X, Levine RA, Hua L et al (2011) Diagnostic value of vena contracta area in the quantification of mitral regurgitation severity by color doppler 3D echocardiography. Circ Cardiovasc Imaging 4:506–513PubMedCrossRef

16.

Khanna D, Vengala S, Miller AP et al (2004) Quantification of mitral regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area. Echocardiography 21:737–743PubMedCrossRef

17.

Iwakura K, Ito H, Kawano S et al (2006) Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation. Am J Cardiol 97:1630–1637PubMedCrossRef

18.

Yosefy C, Hung J, Chua S et al (2009) Direct measurement of vena contracta area by real-time 3-dimensional echocardiography for assessing severity of mitral regurgitation. Am J Cardiol 104:978–983PubMedCrossRef

19.

Hien MD, Weymann A, Rauch H, et al. (2012) Comparison of intraoperative three-dimensional doppler color flow mapping to assess mitral regurgitation. Echocardiography. epub ahead of print

20.

Marsan NA, Westenberg JJM, Ypenburg C et al (2009) Quantification of functional mitral regurgitation by real-time 3d echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance. JACC Cardiovasc Imaging 2:1245–1252PubMedCrossRef

21.

Buck T, Plicht B, Kahlert P et al (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 52:767–778PubMedCrossRef

22.

Biner S, Rafique A, Rafii F et al (2010) Reproducibility of proximal isovelocity surface area, vena contracta, and regurgitant jet area for assessment of mitral regurgitation severity. JACC Cardiovasc Imaging 3:235–243PubMedCrossRef

23.

Utsunomiya T, Doshi R, Patel D et al (1993) Calculation of volume flow rate by the proximal isovelocity surface area method: simplified approach using color Doppler zero baseline shift. J Am Coll Cardiol 22:277–282PubMedCrossRef

24.

Shanks M, Siebelink HM, Delgado V et al (2010) Quantitative assessment of mitral regurgitation: comparison between three-dimensional transesophageal echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging 3:694–700PubMedCrossRef

25.

Grayburn PA, Bhella P (2010) Grading severity of mitral regurgitation by echocardiography: science or art? JACC Cardiovasc Imaging 3:244–246PubMedCrossRef

Title: Quantification of mitral valve regurgitation with color flow Doppler using baseline shift
Authors: Hannah Heß
Sarah Eibel
Chirojit Mukherjee
Udo X. Kaisers
Joerg Ender
Publication date: 01-02-2013
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 2/2013
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-012-0084-7

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Quantification of mitral valve regurgitation with color flow Doppler using baseline shift

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

Please log in to get access to this content

Other articles of this Issue 2/2013

Proximal thoracic aortic diameter measurements at CT: repeatability and reproducibility according to measurement method

Three-dimensional echocardiographic quantitative evaluation of left ventricular diastolic function using analysis of chamber volume and myocardial deformation

Comparison of aortic root measurements in patients undergoing transapical aortic valve implantation (TA-AVI) using three-dimensional rotational angiography (3D-RA) and multislice computed tomography (MSCT): differences and variability

Index of biventricular interdependence calculated using cardiac MRI: a proof of concept study in patients with and without constrictive pericarditis

Speckle tracking echocardiography in acute myocarditis

Comparison of the myocardial clearance of endothelial progenitor cells injected early versus late into reperfused or sustained occlusion myocardial infarction

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