title: True mitral annulus diameter is underestimated by two-dimensional echocardiography as evidenced by real-time three-dimensional echocardiography and magnetic resonance imaging.
abstract: 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.
authors.affiliation: Thoraxcenter, Room Ba 302, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
authors.forename: Ashraf M
authors.initials: AM
authors.lastname: Anwar
authors.forename: Osama I I
authors.initials: OI
authors.lastname: Soliman
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: ten Cate
authors.forename: Attila
authors.initials: A
authors.lastname: Nemes
authors.forename: Jackie S
authors.initials: JS
authors.lastname: McGhie
authors.forename: Boudewijn J
authors.initials: BJ
authors.lastname: Krenning
authors.forename: Robert-Jan
authors.initials: RJ
authors.lastname: van Geuns
authors.forename: Tjebbe W
authors.initials: TW
authors.lastname: Galema
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Geleijnse
mesh_terms: 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