title: Accuracy of three-dimensional versus two-dimensional echocardiography for quantification of aortic regurgitation and validation by three-dimensional three-directional velocity-encoded magnetic resonance imaging.
abstract: Quantitative assessment of aortic regurgitation (AR) remains challenging. The present study evaluated the accuracy of 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiography (TTE) for AR quantification, using 3D 3-directional velocity-encoded magnetic resonance imaging (VE-MRI) as the reference method. Thirty-two AR patients were included. With color Doppler TTE, 2D effective regurgitant orifice area (EROA) was calculated using the proximal isovelocity surface area method. From the 3D TTE multiplanar reformation data, 3D-EROA was calculated by planimetry of the vena contracta. Regurgitant volumes (RVol) were obtained by multiplying the 2D-EROA and 3D-EROA by the velocity-time integral of AR jet and compared with that obtained using VE-MRI. For the entire population, 3D TTE RVol demonstrated a strong correlation and good agreement with VE-MRI RVol (r = 0.94 and -13.6 to 15.6 ml/beat, respectively), whereas 2D TTE RVol showed a modest correlation and large limits of agreement with VE-MRI (r = 0.70 and -22.2 to 32.8 ml/beat, respectively). Eccentric jets were noted in 16 patients (50%). In these patients, 3D TTE demonstrated an excellent correlation (r = 0.95) with VE-MRI, a small bias (0.1 ml/beat) and narrow limits of agreement (-18.7 to 18.8 ml/beat). Finally, the kappa agreement between 3D TTE and VE-MRI for grading of AR severity was good (k = 0.96), whereas the kappa agreement between 2D TTE and VE-MRI was suboptimal (k = 0.53). In conclusion, AR RVol quantification using 3D TTE is accurate, and its advantage over 2D TTE is particularly evident in patients with eccentric jets.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: See Hooi
authors.initials: SH
authors.lastname: Ewe
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Rob
authors.initials: R
authors.lastname: van der Geest
authors.forename: Jos J M
authors.initials: JJ
authors.lastname: Westenberg
authors.forename: Marlieke L A
authors.initials: ML
authors.lastname: Haeck
authors.forename: Tomasz G
authors.initials: TG
authors.lastname: Witkowski
authors.forename: Dominique
authors.initials: D
authors.lastname: Auger
authors.forename: Nina Ajmone
authors.initials: NA
authors.lastname: Marsan
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Allard
authors.initials: A
authors.lastname: Sieders
authors.forename: Hans-Marc J
authors.initials: HM
authors.lastname: Siebelink
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D015897:Comorbidity; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index