title: Quantitative assessment of primary mitral regurgitation using left ventricular volumes: a three-dimensional transthoracic echocardiographic pilot study.
abstract: OBJECTIVE
  To investigate the value of assessment of mitral regurgitant fraction (RF) using left ventricular (LV) volumes obtained by three-dimensional echocardiography (3DE) to quantify primary mitral regurgitation (MR).
  
  
  RESULTS
  Sixty patients with primary MR in sinus rhythm were prospectively enrolled. RF was calculated using either 2DE or 3DE LV volumes obtained as follows: (LV total stroke volume - LV forward stroke volume by Doppler)/LV total stroke volume. Severity of MR was graded independently by two cardiologists blinded to LV volumetric data using an integrative approach, as recommended by current guidelines. Sixty patients with LV ejection fraction >50% and no MR were also studied. In patients without MR, 3D total LV stroke volume was more strongly correlated with LV forward stroke volume than 2D total LV stroke volume (r = 0.75, P < 0.0001 vs. r = 0.62, P < 0.0001, respectively). The 3D method had a feasibility of 90% in patients with MR. Inter-reader concordance for MR grading (four grades) was excellent with a Kappa-value of 0.90, P < 0.0001. A significant correlation was observed between grade of MR severity and 3D RF (r = 0.83, P < 0.0001) and 2D RF (r = 0.74, P < 0.0001). Comparisons between individual grades for 3D RF were significant (P < 0.05) except for 3+ vs. 4+ MR (P = 0.213). All patients with 3D RF ≥40% had ≥3+ or 4+ MR and those with 3D RF ≤30% had 1+ or 2+ MR with a 'grey' overlap zone between 30 and 40%.
  
  
  CONCLUSIONS
  RF can be routinely determined using 3D LV volumes with a high feasibility in patients with primary MR and is reliable for identification of Grade 3+ or Grade 4+ MR. The incorporation of this parameter into the currently recommended multiparametric integrative approach might be helpful to discriminate significant MR.
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France INSERM U 1088 Université de Picardie, Amiens, France sylvestre.marechaux@yahoo.fr.
authors.forename: Sylvestre
authors.initials: S
authors.lastname: Maréchaux
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Le Goffic
authors.affiliation: Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
authors.forename: Pierre-Vladimir
authors.initials: PV
authors.lastname: Ennezat
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Semichon
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Castel
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France.
authors.forename: François
authors.initials: F
authors.lastname: Delelis
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France.
authors.forename: Jean Michel
authors.initials: JM
authors.lastname: Lemahieu
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France.
authors.forename: Aymeric
authors.initials: A
authors.lastname: Menet
authors.affiliation: Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Graux
authors.affiliation: INSERM U 1088 Université de Picardie, Amiens, France Centre Hospitalier Universitaire d'Amiens, Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
mesh_terms: D015897:Comorbidity; D004452:Echocardiography / Q000379:methods*; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D011446:Prospective Studies; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
keywords: Three-dimensional echocardiography; primary mitral regurgitation; three-dimensional left ventricular volumes; valvular heart disease