Optimal Quantification of Functional Mitral Regurgitation: Comparison of Volumetric and Proximal Isovelocity Surface Area Methods to Predict Outcome - PubMed (original) (raw)

Comparative Study

. 2021 Jun;10(11):e018553.

doi: 10.1161/JAHA.120.018553. Epub 2021 May 22.

Affiliations

Comparative Study

Optimal Quantification of Functional Mitral Regurgitation: Comparison of Volumetric and Proximal Isovelocity Surface Area Methods to Predict Outcome

Sachiyo Igata et al. J Am Heart Assoc. 2021 Jun.

Abstract

Background Effective orifice area (EOA) ≥0.2 cm2 or regurgitant volume (Rvol) ≥30 mL predicts prognostic significance in functional mitral regurgitation (FMR). Both volumetric and proximal isovelocity surface area (PISA) methods enable calculation of these metrics. To determine their clinical value, we compared EOA and Rvol derived by volumetric and PISA quantitation upon outcome of patients with FMR. Methods and Results We examined the outcome of patients with left ventricular ejection fraction <35% and moderate to severe FMR. All had a complete echocardiogram including EOA and Rvol by both standard PISA and volumetric quantitation using total stroke volume calculated by left ventricular end-diastolic volume×left ventricular ejection fraction and forward flow by Doppler method: EOA=Rvol/mitral regurgitation velocity time integral. Primary outcome was all-cause mortality or heart transplantation. We examined 177 patients: mean left ventricular ejection fraction 25.2% and 34.5% with ischemic cardiomyopathy. Echo measurements were greater by PISA than volumetric quantitation: EOA (0.18 versus 0.11 cm2), Rvol (24.7 versus 16.9 mL), and regurgitant fraction (61 versus 37 %) respectively (all P value <0.001). During 3.6±2.3 years' follow-up, patients with EOA ≥0.2 cm2 or Rvol ≥30 mL had a worse outcome than those with EOA <0.2 cm2 or Rvol <30 mL only by volumetric (log rank _P_=0.003 and 0.004) but not PISA quantitation (log rank _P_=0.984 and 0.544), respectively. Conclusions Volumetric and PISA methods yield different measurements of EOA and Rvol in FMR; volumetric values exhibit greater prognostic significance. The echo method of quantifying FMR may affect the management of this disorder.

Keywords: functional mitral regurgitation; outcome; proximal isovelocity surface area (PISA) method; volumetric method.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1

Figure 1. Flow diagram of study subjects.

2D indicates 2‐dimensional; FMR, functional mitral regurgitation; and LVEF, left ventricular ejection fraction.

Figure 2

Figure 2. Comparison of the (A) effective orifice area, (B) regurgitant volume (Rvol), and (C) regurgitant fraction (RF) between the volumetric (VOL) and proximal isovelocity surface area (PISA) method.

Figure 3

Figure 3. Correlation of effective orifice area (EOA) and left ventricular (LV) end‐diastolic volume.

A, EOA obtained from volumetric method. B, EOA obtained from proximal isovelocity surface area (PISA) method.

Figure 4

Figure 4. Outcome in patients with and without effective orifice area (EOA) ≥0.2 cm2 by volumetric or proximal isovelocity surface area (PISA) method.

Figure 5

Figure 5. Outcome in patients with and without regurgitant volume (Rvol) ≥30 mL by volumetric or proximal isovelocity surface area (PISA) method.

Figure 6

Figure 6. The receiver operating characteristic curves of effective orifice area (EOA) and regurgitant volume (Rvol) for predicting of death and heart transplant.

AUC indicates area under the curve.

Comment in

References

    1. Saito K, Okura H, Watanabe N, Obase K, Tamada T, Koyama T, Hayashida A, Neishi Y, Kawamoto T, Yoshida K. Influence of chronic tethering of the mitral valve on mitral leaflet size and coaptation in functional mitral regurgitation. JACC Cardiovasc Imaging. 2012;5:337–345. DOI: 10.1016/j.jcmg.2011.10.004. -DOI -PubMed
    1. Silbiger JJ. Mechanistic insights into ischemic mitral regurgitation: echocardiographic and surgical implications. J Am Soc Echocardiogr. 2011;24:707–719. DOI: 10.1016/j.echo.2011.04.001. -DOI -PubMed
    1. Daimon M, Saracino G, Fukuda S, Koyama Y, Kwan J, Song JM, Agler DA, Gillinov AM, Thomas JD, Shiota T. Dynamic change of mitral annular geometry and motion in ischemic mitral regurgitation assessed by a computerized 3D echo method. Echocardiography. 2010;27:1069–1077. DOI: 10.1111/j.1540-8175.2010.01204.x. -DOI -PubMed
    1. Agricola E, Oppizzi M, Maisano F, De Bonis M, Schinkel AF, Torracca L, Margonato A, Melisurgo G, Alfieri O. Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern. Eur J Echocardiogr. 2004;5:326–334. DOI: 10.1016/j.euje.2004.03.001. -DOI -PubMed
    1. Ray S. The echocardiographic assessment of functional mitral regurgitation. Eur J Echocardiogr. 2010;11:i11–i17. DOI: 10.1093/ejechocard/jeq121. -DOI -PubMed

Publication types

MeSH terms

LinkOut - more resources