title: 3D Xplane Echocardiographic Technique for Validation of Mitral Leaflet Separation to Assess Severity of Mitral Stenosis.
abstract: BACKGROUND
  Determining the severity of mitral stenosis (MS) is important for both prognostic and therapeutic implications. Mitral valve area (MVA) calculation techniques have more limitations. Mitral leaflet separation (MLS) is a precise and operator friendly alternative to planimetry. In contrast to previous researchers, we have used a novel 3D Xplane technique to validate MLS for assessing the severity of MS. 3D Xplane is superior for validation of MLS due to simultaneous real time acquisition of MLS in parasternal long-axis view and corresponding MVA by planimetry in parsternal short-axis view.
  
  
  METHODS
  It was a prospective observational single center study. A total of 174 patients with MS were evaluated for MVA estimation by various echocardiographic modalities. Maximum leaflet separation and corresponding planimetered MVA were measured using novel 3D Xplane technique.
  
  
  RESULTS
  With 3D Xplane technique, there was strong positive correlation between planimetered MVA and MLS (R = 0.925, P < 0.001), irrespective of coexisting MR (R = 0.886, P < 0.001) or AF (R = 0.912, P < 0.001). Receiver operating characteristic curves of MLS demonstrated AUC for mild and severe MS to be 0.966 and 0.995, respectively. MLS less than 8.62 mm predicted severe MS with 95.5% sensitivity and 94.7% specificity and MLS more than 12.23 mm predicted mild MS with 93.2% sensitivity and 91.4% specificity.
  
  
  CONCLUSIONS
  In our study, a strong correlation between planimetered MVA and MLS was found using 3D Xplane technique. 3D Xplane thus validates and standardizes MLS by excluding errors due to temporal and spatial variations which are important limitations of 2D echocardiography.
authors.affiliation: Postgraduate Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India.
authors.forename: Rajendra K
authors.initials: RK
authors.lastname: Gokhroo
authors.affiliation: Postgraduate Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India.
authors.forename: Bhanwar L
authors.initials: BL
authors.lastname: Ranwa
authors.affiliation: Postgraduate Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India.
authors.forename: Kamal
authors.initials: K
authors.lastname: Kishor
authors.affiliation: Postgraduate Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India.
authors.forename: Kumari
authors.initials: K
authors.lastname: Priti
authors.affiliation: Postgraduate Department of Cardiology, JLN Medical College, Ajmer, Rajasthan, India.
authors.forename: Ananthraj
authors.initials: A
authors.lastname: Avinash
authors.affiliation: Escorts Heart Hospital, New Delhi, India.
authors.forename: Sajal
authors.initials: S
authors.lastname: Gupta
authors.affiliation: ACE Heart and Vascular Institute, Mohali, Punjab, India.
authors.forename: Devendra
authors.initials: D
authors.lastname: Bisht
mesh_terms: D000328:Adult; D000465:Algorithms; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008946:Mitral Valve Stenosis / Q000145:classification / Q000000981:diagnostic imaging*; D056888:Patient Positioning / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: 3D Xplane echocardiography; correlation; mitral leaflet separation; mitral valve area; planimetry; validation