title: Quantitative assessment of mitral regurgitation: comparison between three-dimensional transesophageal echocardiography and magnetic resonance imaging.
abstract: BACKGROUND
  quantification of mitral regurgitation severity with 2-dimensional (2D) imaging techniques remains challenging. The present study compared the accuracy of 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE for quantification of mitral regurgitation, using MRI as the reference method.
  
  
  RESULTS
  two-dimensional and 3D TEE and cardiac MRI were performed in 30 patients with mitral regurgitation. Mitral effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were estimated with 2D and 3D TEE. With 3D TEE, EROA was calculated using planimetry of the color Doppler flow from en face views and Rvol was derived by multiplying the EROA by the velocity time integral of the regurgitant jet. Finally, using MRI, mitral Rvol was quantified by subtracting the aortic flow volume from left ventricular stroke volume. Compared with 3D TEE, 2D TEE underestimated the EROA by a mean of 0.13 cm(2). In addition, 2D TEE underestimated the Rvol by 21.6% when compared with 3D TEE and by 21.3% when compared with MRI. In contrast, 3D TEE underestimated the Rvol by only 1.2% when compared with MRI. Finally, one third of the patients in grade 1 and ≥50% of the patients in grade 2 and 3, as assessed with 2D TEE, would have been upgraded to a more severe grade, based on the 3D TEE and MRI measurements.
  
  
  CONCLUSIONS
  quantification of mitral EROA and Rvol with 3D TEE is feasible and accurate as compared with MRI and results in less underestimation of the Rvol as compared with 2D TEE.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Miriam
authors.initials: M
authors.lastname: Shanks
authors.forename: Hans-Marc J
authors.initials: HM
authors.lastname: Siebelink
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Nico R L
authors.initials: NR
authors.lastname: van de Veire
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.forename: Allard
authors.initials: A
authors.lastname: Sieders
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Schuijf
authors.forename: Hildo J
authors.initials: HJ
authors.lastname: Lamb
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.forename: Jos J M
authors.initials: JJ
authors.lastname: Westenberg
authors.forename: Lucia J
authors.initials: LJ
authors.lastname: Kroft
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D001783:Blood Flow Velocity; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D008944:Mitral Valve Insufficiency / Q000175:diagnosis*; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume