Quantitative assessment of primarymitral regurgitation using left ventricular volumes: A three-dimensional transthoracic echocardiographic pilot study

Abstract

Aims To investigate the value of assessment of mitral regurgitant fraction (RF) using left ventricular (LV) volumes obtained by three-dimensional echocardiography (3DE) to quantify primary mitral regurgitation (MR). Methods and results Sixty patients with primaryMRin sinus rhythmwere prospectively enrolled. RFwas calculated using either2DEor3DELV volumes obtained as follows: (LV total stroke volume 2 LV forward stroke volume by Doppler)/LV total stroke volume. Severity of MR was graded independently by two cardiologists blinded to LV volumetric data using an integrative approach, as recommended by current guidelines. Sixty patients with LV ejection fraction .50% and no MR were also studied. In patients without MR, 3D total LV stroke volume was more strongly correlated with LV forward stroke volume than 2D total LV stroke volume (r = 0.75, P < 0.0001 vs. r = 0.62, P < 0.0001, respectively). The 3D method had a feasibility of 90% in patients with MR. Inter-reader concordance for MR grading (four grades) was excellent with a Kappa-value of 0.90, P < 0.0001. A significant correlation was observed between grade of MR severity and 3D RF (r = 0.83, P < 0.0001) and 2DRF (r = 0.74, P < 0.0001). Comparisons between individual grades for 3DRF were significant (P < 0.05) except for 3± vs. 4± MR(P = 0.213). All patients with3DRF ≥40% had ≥3± or 4± MRand those with 3D RF ≤30% had 1± or 2± MR with a 'grey' overlap zone between 30 and 40%. Conclusions RF can be routinely determined using 3D LV volumes with a high feasibility in patients with primary MR and is reliable for identification of Grade 3±or Grade4±MR.The incorporation of this parameter into the currently recommendedmultiparametric integrative approach might be helpful to discriminate significant MR Published on behalf of the European Society of Cardiology. All rights reserved.