title: Efficacy and Accuracy of Novel Automated Mitral Valve Quantification: Three-Dimensional Transesophageal Echocardiographic Study.
abstract: BACKGROUND
  Previous studies indicated that the three-dimensional features of the mitral valve (MV) have a significant impact on MV disease. However, quantification of MV with manual tracing software was too time-consuming for routine clinical practice. This study was performed to investigate the efficacy and accuracy of MV quantification with a novel highly automated commercially available software package developed for this purpose.
  
  
  METHODS
  Using the manual tracing and automated package, two expert sonographers and one cardiologist individually analyzed three-dimensional datasets acquired with transesophageal echocardiography from 74 patients (15 with functional mitral regurgitation, 32 with MV prolapse, and 27 normal subjects) retrospectively. Time for analysis and inter-observer agreement were compared between the two methods, and agreement of measurements was analyzed using Cronbach's α.
  
  
  RESULTS
  Time for analysis using the automated package was significantly shorter than manual tracing (whole cohort, 260 ± 65 vs. 381 ± 68 seconds, P < 0.001; functional mitral regurgitation, 234 ± 42 vs. 378 ± 64 seconds, P < 0.001; MV prolapse, 293 ± 69 vs. 407 ± 67 seconds, P < 0.001; normal controls, 235 ± 52 vs. 351 ± 60 seconds, P < 0.001). There was good agreement among all three observers using both methods, and measurements with the automated package agreed well with the manual tracing values.
  
  
  CONCLUSIONS
  The novel automated software package reduced time for quantification of MV with similar accuracy compared to the manual method. Automated quantification is useful and may be a key to widespread adoption of three-dimensional quantification in clinical practice.
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Nobuyuki
authors.identifier: http://orcid.org/0000-0002-2305-0049
authors.initials: N
authors.lastname: Kagiyama
authors.affiliation: Department of Laboratory Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Misako
authors.initials: M
authors.lastname: Toki
authors.affiliation: Department of Medical Innovation, Osaka University Hospital, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hara
authors.affiliation: Department of Laboratory Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Fukuda
authors.affiliation: Department of Laboratory Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Aritaka
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Miki
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Minako
authors.initials: M
authors.lastname: Ohara
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hayashida
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hirohata
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Yamamoto
authors.affiliation: Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D000465:Algorithms; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D000069550:Machine Learning; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D008945:Mitral Valve Prolapse / Q000000981:diagnostic imaging*; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: mitral regurgitation; mitral valve; three-dimensional transesophageal echocardiography; transesophageal echocardiography; valvular regurgitation