title: Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation: an accurate and novel approach.
abstract: 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.
authors.affiliation: Echocardiography Laboratory, Hospital Clínico San Carlos, Madrid, Spain. jlzamorano@vodafone.es
authors.forename: José
authors.initials: J
authors.lastname: Zamorano
authors.forename: Pedro
authors.initials: P
authors.lastname: Cordeiro
authors.forename: Lissa
authors.initials: L
authors.lastname: Sugeng
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Perez de Isla
authors.forename: Lynn
authors.initials: L
authors.lastname: Weinert
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodríguez
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
mesh_terms: 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