title: Diagnostic value of color flow mapping and Doppler echocardiography in the quantification of mitral regurgitation in patients with mitral valve prolapse or rheumatic heart disease.
abstract: OBJECTIVE
  The objective was to analyze the diagnostic value of the echocardiographic methods used for quantification of mitral regurgitation (MR) in patients with mitral valve prolapse (MVP) or rheumatic heart disease (RHD).
  
  
  METHODS
  The study included 50 patients with MR (mean age of 46.1 years; 35 women), 27 (54%) with RHD and 23 (46%) with MVP. Quantification of the mitral valve regurgitation was obtained by regurgitant orifice area (ROA) and regurgitant volume (RV) by the flow convergence region (FCR) and two-dimensional Doppler echocardiographic methods, regurgitant fraction, jet area (JA), jet area/left atrial area ratio (JA/LAA), and vena contracta (VC). Patients were clinically followed to identify cardiovascular events. Data were analyzed by Pearson, kappa, and receiver operator characteristic curve tests; significance was defined as a P value less than .05.
  
  
  RESULTS
  The correlation between the two methods for ROA and RV were r = 0.79 and r = 0.80, respectively, and between these parameters and regurgitant fraction, VC, JA, and JA/LAA varied from r = 0.54 to r = 0.94 (P lt; .05); the agreement varied from kappa = 0.19 to kappa = 0.83. The highest accuracy to identify patients with clinically significant MR (events at follow-up) was 96% for ROA by FCR, 94% for VC, 86% for RV by FCR, and 86% for JA. No method showed a significant difference between MVP and RHD.
  
  
  CONCLUSIONS
  The methods analyzed had significant correlation and good agreement. ROA by FCR and VC had the best performance to identify severe MR; no significant difference between MVP and RHD was observed.
authors.affiliation: Disciplina de Cardiologia, Escola Paulista de Medicina-UNIFESP, São Paulo, SP, Brasil.
authors.forename: Aurélio Carvalho
authors.initials: AC
authors.lastname: Pinheiro
authors.forename: Frederico José Neves
authors.initials: FJ
authors.lastname: Mancuso
authors.forename: Daniela Fernanda Alli
authors.initials: DF
authors.lastname: Hemerly
authors.forename: Alberto Takeshi
authors.initials: AT
authors.lastname: Kiyose
authors.forename: Orlando
authors.initials: O
authors.lastname: Campos
authors.forename: José Lázaro
authors.initials: JL
authors.lastname: de Andrade
authors.forename: Angelo Amato Vicenzo
authors.initials: AA
authors.lastname: de Paola
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: de Camargo Carvalho
authors.forename: Valdir Ambrosio
authors.initials: VA
authors.lastname: Moises
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology*; D003937:Diagnosis, Differential; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008945:Mitral Valve Prolapse / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012720:Severity of Illness Index