Clinical applicability for the assessment of the valvular mitral stenosis severity with Doppler echocardiography and the proximal isovelocity surface area (PISA) method.
Evaluation of the severity of valvular mitral stenosis and measurements of the effective rheumatic mitral valve area by noninvasive echocardiography has been well accepted. The area is measured by the two-dimensional planimetry (PLM) method and the Doppler pressure half-time (PHT) method. Recently, the proximal isovelocity surface area (PISA) by color Doppler technique has been used as a quantitative measurement for valvular heart disease. However, this method needs more validation. The aim of this study was therefore to investigate the clinical applicability of the PISA method in the measurements of effective mitral valve area in patients with rheumatic valvular heart disease. Forty-seven patients aged from 23 to 71 years, with a mean age of 53 +/- 13 (25 male and 22 female, 15 with sinus rhythm, mean heart rate of 83 +/- 14 beats per minute, with rheumatic valvular mitral stenosis without hemodynamically significant mitral regurgitation) were included in the study. Effective mitral valve area (MVA) derived by the PISA method was calculated as follows: 2 x Pi x (proximal aliasing color zone radius)2x aliasing velocity/peak velocity across mitral orifice. Effective mitral valve areas measured by three different methods (PLM, PHT, and PISA) were compared and correlated with those calculated by the "gold standard" invasive Gorlin's formula. The MVA derived from PHT, PLM, PISA and Gorlin's formula were 1.00 +/- 0.31cm2, 0.99 +/- 0.30 cm2, 0.95 +/- 0.30 cm2 and 0.91 +/- 0.29 cm2, respectively. The correlation coefficients (r value) between PHT, PLM, PISA, and Gorlin's formula, respectively, were 0.66 (P = 0.032, SEE = 0.64), 0.67 (P = 0.25, SEE = 0.72) and 0.80 (P = 0.002, SEE = 0.53). In conclusion, the PISA method is useful clinically in the measurement of effective mitral valve area in patients with rheumatic mitral valve stenosis. The technique is relatively simple, highly feasible and accurate when compared with the PHT, PLM, and Gorlin's formula. Therefore, this method could be a promising supplement to methods already in use.
Lee
Tao Yu
TY
Division of Cardiology, Kaohsiung Veteran General Hospital, Kaohsiung, Taiwan, ROC. dlee@isca.vghks.gov.tw
Tseng
Chi-Jen
CJ
Chiao
Chia-Ding
CD
Chiou
Chuen-Wang
CW
Mar
Guang-Yuan
GY
Liu
Chun-Peng
CP
Lin
Shao Lin
SL
Chiang
Hung-Tin
HT
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001783:Blood Flow Velocity; D017023:Coronary Angiography; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008433:Mathematics; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012720:Severity of Illness Index