[Evaluation of mitral regurgitation severity using a simplified method based on proximal flow convergence].
OBJECTIVE
Calculation of the effective regurgitant orifice (ERO) is regarded as the most accurate way of assessing the severity of mitral regurgitation (MR), but the technique's complexity limits its use. Our objective was to modify and validate a previously published semiquantitative method of assessment based on measurement of the proximal isovelocity surface area (PISA) in order to adapt it to recent recommendations from American and European cardiology societies.


METHODS
In the PISA method, maximum regurgitant flow (MRF) is a function of the radius and aliasing velocity (AV). Using this relationship, it is possible to construct a nomogram formed by lines of different MRF value, which can be easily derived by looking for radius values on the graph and observing where they cross with AV values. The MR severity limits on the nomogram were set to reflect the different severity grades and limits recommended for use with ERO measurements by American and European cardiology societies.


RESULTS
We studied 76 patients with MR using Doppler echocardiography. There was an excellent correlation between MRF and ERO (r=0.98, P< .001). Estimates of MR severity made using the new nomogram were in good agreement with those derived from the ERO: for a scale with three severity grades, kappa was 0.951 and the standard error was 0.11; for four grades, kappa was 0.969 and the standard error, 0.11.


CONCLUSIONS
Estimates of MR severity derived semiquantitatively from MRF using the nomogram proposed here were in excellent agreement with quantitative estimates obtained using the ERO, and the method was faster and easier to use.
Moya
José L
JL
Instituto de Enfermedades Cardiacas, Hospital Universitario Ramón y Cajal, Madrid, Spain. jmoya.hrc@salud.madrid.org
Darriba-Pollán
Julia
J
García-Lledó
Alberto
A
Taboada
Dolores
D
Catalán-Sanz
Paz
P
Megías-Saez
Alicia
A
Guzmán-Martínez
Gabriela
G
Campuzano-Ruiz
Raquel
R
Asín-Cardiel
Enrique
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D003627:Data Interpretation, Statistical; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D008955:Models, Cardiovascular; D012720:Severity of Illness Index