Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A transoesophageal 3D colour Doppler analysis in 500 patients

Abstract

Aims Vena contracta area (VCA 3D), derived by 3D colour Doppler echocardiography, has already been validated against cardiac magnetic resonance imaging, but the number of clinical studies to define cut-off values for grading of mitral regurgitation (MR) is limited. Aim of the study was to assess VCA 3D in a large population of patients with functional (FMR) and degenerative MR (DMR). Methods and results Transoesophageal echocardiography was performed in 500 patients with MR. The following 2D parameters were assessed for grading of MR: vena contracta width, effective regurgitant orifice area (EROA PISA), and regurgitation volume (RV PISA). VCA 3D and the corresponding regurgitation volume (RV VCA) were quantified using 3D colour Doppler loop and CW Doppler tracing of the regurgitant jet. In 104 patients a 3D dataset of the left ventricle (LV) and the left ventricular outflow tract (LVOT) was acquired. As a reference method, regurgitation volume (RV 3D) was calculated as difference between LV overall and LVOT stroke volumes. For prediction of severe MR, VCA 3D yielded higher values of area under the ROC curve compared to EROA PISA (overall patient group 0.98 for VCA 3D vs. 0.90 for EROA PISA, P < 0.001; FMR group 0.97 for VCA 3D vs. 0.92 for EROA PISA, P = 0.002). RV VCA correlated closer with RV 3D compared to RV PISA (r = 0.96 for RV PISA, r = 0.79 for RV PISA). Conclusion This study delivers cut-off values for VCA 3D in patients with different types of MR. VCA 3D is a robust parameter for quantification of MR, showing a good correlation with the reference method using 3D datasets of LV.