| Proximal flow convergence region as assessed by real-time 3-dimensional echocardiography: challenging the hemispheric assumption. | |
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MedLine Citation:
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PMID: 17400118 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Traditionally, a hemispheric assumption for the proximal flow convergence region (PFCR) is used when calculating mitral regurgitant (MR) effective orifice area (EROA). However, 2-dimensional (2D) echocardiography limits evaluation of the complete PFCR contour. Real-time 3-dimensional (3D) echocardiography (RT3D) allows direct assessment of the true PFCR contour. We hypothesized that the PFCR contour is not necessarily hemispheric, but rather hemielliptic, and aimed to apply a hemielliptic calculation, based on the 3D contour of the PFCR for more accurate MR quantification. METHODS: In all, 50 patients with MR underwent RT3D to characterize PFCR contour as hemispheric or hemielliptic. MR EROA by RT3D-derived PFCR was calculated using a hemielliptic formula using 3D data. The 2D EROA was computed using standard hemispheric assumption. EROAs calculated from 2D and RT3D data were compared with quantitative Doppler EROA (mitral inflow--aortic outflow/MR time-velocity integral), used as an independent comparison. RESULTS: Only 1 of 50 patients (2%) had a hemispheric PFCR contour by RT3D. The remaining had hemielliptic PFCR contours. Compared with Doppler method, 2D echocardiography significantly underestimated EROA (0.34 +/- 0.14 vs 0.48 +/- 0.25 cm(2), P < .001). RT3D EROA was not significantly different from Doppler EROA (0.52 +/- 0.17 vs 0.48 +/- 0.25, P = not significant). Of 33 patients with Doppler EROA greater than 0.3 cm(2) (> or =moderate-severe MR), 45% (15 of 33) were underestimated as having mild to moderate MR by 2D EROA. CONCLUSIONS: The true PFCR contour as shown by RT3D is generally not hemispheric but hemielliptic, tracking the orifice contour. Based on this 3D shape, a hemielliptic approach can be used for practical clinical application with improved MR quantification. |
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Authors:
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Chaim Yosefy; Robert A Levine; Jorge Solis; Mordehay Vaturi; Mark D Handschumacher; Judy Hung |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Volume: 20 ISSN: 1097-6795 ISO Abbreviation: J Am Soc Echocardiogr Publication Date: 2007 Apr |
Date Detail:
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Created Date: 2007-04-02 Completed Date: 2007-06-05 Revised Date: 2007-11-14 |
Medline Journal Info:
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Nlm Unique ID: 8801388 Medline TA: J Am Soc Echocardiogr Country: United States |
Other Details:
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Languages: eng Pagination: 389-96 Citation Subset: IM |
Affiliation:
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Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114-2696, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Echocardiography, Doppler Echocardiography, Three-Dimensional / methods* Female Humans Male Mitral Valve / physiopathology, ultrasonography* Mitral Valve Insufficiency / physiopathology*, ultrasonography Myocardial Contraction / physiology* Observer Variation Reproducibility of Results Severity of Illness Index |
| Grant Support | |
ID/Acronym/Agency:
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K23 HL04504/HL/NHLBI NIH HHS; K24 HL67434/HL/NHLBI NIH HHS; R01 HL38176/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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