True mitral annulus diameter is underestimated by two-dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging.
BACKGROUND
Mitral annulus assessment is of great importance for the diagnosis and treatment of mitral valve disease. The present study sought to assess the value of real-time three-dimensional echocardiography for the assessment of true mitral annulus diameter (MAD).


METHODS
One hundred and fifty patients (mean age 38 +/- 18 years) with adequate two-dimensional (2D) echocardiographic image quality underwent assessment of MAD(2D) and MAD(3D) (with real-time three-dimensional echocardiography). In a subgroup of 30 patients true MAD was validated with magnetic resonance imaging (MRI).


RESULTS
There was a good interobserver agreement for MAD(2D) (mean difference = -0.25 +/- 2.90 mm, agreement: -3.16, 2.66) and MAD(3D) (mean difference = 0.29 +/- 2.03, agreement = -1.74, 2.32). Measurements of MAD(2D) and MAD(3D) were well correlated (R = 0.81, P < 0.0001). However, MAD(3D) was significantly larger than MAD(2D) (3.7 +/- 0.9 vs. 3.3 +/- 0.8 cm, P < 0.0001). In the subgroup of 30 patients with MRI validation, MAD(3D) and MAD(MRI) were significantly larger than MAD(2D) (3.3 +/- 0.5 and 3.4 +/- 0.5 cm vs. 2.9 +/- 0.4 cm, both P < 0.001). There was no significant difference between MAD(MRI) and MAD(3D).


CONCLUSIONS
MAD(3D) can be reliably measured and is superior to MAD(2D) in the assessment of true mitral annular size.
Anwar
Ashraf M
AM
Thoraxcenter, Room Ba 302, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
Soliman
Osama I I
OI
ten Cate
Folkert J
FJ
Nemes
Attila
A
McGhie
Jackie S
JS
Krenning
Boudewijn J
BJ
van Geuns
Robert-Jan
RJ
Galema
Tjebbe W
TW
Geleijnse
Marcel L
ML
D000328:Adult; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D015588:Observer Variation; D015203:Reproducibility of Results; D012107:Research Design