Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach.
OBJECTIVE
Our aim was to assess which echo-Doppler method has the best agreement with the mitral valve area (MVA) invasively evaluated by the Gorlin's formula. We also evaluated the feasibility and reproducibility of real-time three-dimensional echocardiography (RT3D) for the estimation of MVA and the Wilkins score in patients with rheumatic mitral stenosis (RMVS).


BACKGROUND
Real-time three-dimensional echocardiography is a novel technique that allows us to visualize the mitral valvular anatomy in any desired plane orientation. The usefulness and accuracy of this technique for evaluating RMVS has not been established.


METHODS
We studied a series of consecutive patients with RMVS from two tertiary care hospitals. Mitral valvular area was determined by conventional echo-Doppler methods and by RT3D, and their results were compared with those obtained invasively. Real-time three-dimensional echocardiography planimetry and mitral score were measured by two independent observers and then repeated by one of them.


RESULTS
Eighty patients with RMVS comprised our study group (76 women; 50.6 +/- 13.9 years). Compared with all other echo-Doppler methods, RT3D had the best agreement with the invasively determined MVA (average difference between both methods and limits of agreement: 0.08 cm(2) [-0.48 to 0.6]). Interobserver variability was as good for RT3D (intraclass correlation coefficient [ICC] = 0.90) as for pressure half-time (PHT) (ICC = 0.95). For PHT and RT3D, the intraobserver variability was similar (ICC 0.92 and 0.96, respectively). Real-time three-dimensional echocardiography valvular score evaluation showed a better interobserver agreement with RT3D than with 2D echocardiography.


CONCLUSIONS
Real-time three-dimensional echocardiography is a feasible, accurate, and highly reproducible technique for assessing MVA in patients with RMVS. Real-time three-dimensional echocardiography has the best agreement with invasive methods.
Zamorano
José
J
Echocardiography Laboratory, Hospital Clínico San Carlos, Madrid, Spain. jlzamorano@vodafone.es
Cordeiro
Pedro
P
Sugeng
Lissa
L
Perez de Isla
Leopoldo
L
Weinert
Lynn
L
Macaya
Carlos
C
Rodríguez
Enrique
E
Lang
Roberto M
RM
D019560:Echocardiography, Three-Dimensional / Q000592:standards*; D005260:Female; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging*; D015588:Observer Variation; D011237:Predictive Value of Tests; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging*; D013030:Spain