Document Detail


Three-dimensional color Doppler echocardiography for direct measurement of vena contracta area in mitral regurgitation: in vitro validation and clinical experience.
MedLine Citation:
PMID:  19356505     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Our goal was to prospectively compare the accuracy of real-time three-dimensional (3D) color Doppler vena contracta (VC) area and two-dimensional (2D) VC diameter in an in vitro model and in the clinical assessment of mitral regurgitation (MR) severity. BACKGROUND: Real-time 3D color Doppler allows direct measurement of VC area and may be more accurate for assessment of MR than the conventional VC diameter measurement by 2D color Doppler. METHODS: Using a circulatory loop with an incorporated imaging chamber, various pulsatile flow rates of MR were driven through 4 differently sized orifices. In a clinical study of patients with at least mild MR, regurgitation severity was assessed quantitatively using Doppler-derived effective regurgitant orifice area (EROA), and semiquantitatively as recommended by the American Society of Echocardiography. We describe a step-by-step process to accurately identify the 3D-VC area and compare that measure against known orifice areas (in vitro study) and EROA (clinical study). RESULTS: In vitro, 3D-VC area demonstrated the strongest correlation with known orifice area (r = 0.92, p < 0.001), whereas 2D-VC diameter had a weak correlation with orifice area (r = 0.56, p = 0.01). In a clinical study of 61 patients, 3D-VC area correlated with Doppler-derived EROA (r = 0.85, p < 0.001); the relation was stronger than for 2D-VC diameter (r = 0.67, p < 0.001). The advantage of 3D-VC area over 2D-VC diameter was more pronounced in eccentric jets (r = 0.87, p < 0.001 vs. r = 0.6, p < 0.001, respectively) and in moderate-to-severe or severe MR (r = 0.80, p < 0.001 vs. r = 0.18, p = 0.4, respectively). CONCLUSIONS: Measurement of VC area is feasible with real-time 3D color Doppler and provides a simple parameter that accurately reflects MR severity, particularly in eccentric and clinically significant MR where geometric assumptions may be challenging.
Authors:
Stephen H Little; Bahar Pirat; Rahul Kumar; Stephen R Igo; Marti McCulloch; Craig J Hartley; Jiaqiong Xu; William A Zoghbi
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Publication Detail:
Type:  Comparative Study; Journal Article; Validation Studies     Date:  2008-11-18
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  1     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2009-04-09     Completed Date:  2009-04-23     Revised Date:  2009-05-21    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  695-704     Citation Subset:  IM    
Affiliation:
The Methodist DeBakey Heart and Vascular Center, Houston, Texas 77030, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Echocardiography, Doppler, Color*
Echocardiography, Three-Dimensional*
Feasibility Studies
Female
Hemorheology
Humans
Image Interpretation, Computer-Assisted
Male
Middle Aged
Mitral Valve / physiopathology,  ultrasonography*
Mitral Valve Insufficiency / physiopathology,  ultrasonography*
Observer Variation
Predictive Value of Tests
Prospective Studies
Pulsatile Flow
Reproducibility of Results
Severity of Illness Index
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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