Elkoumy A, Attia W, Fahem NA, Al-Deftar M, Ahmed TA, and Said T
Background:2D PISA method has some technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Real-time three-dimensional (3D) color Doppler imaging allows measurement of PISA without geometric assumptions. The aim of this study was to validate this method in patients with chronic mitral regurgitation (MR).
Methods:25 patients were included, ten (40%) with rheumatic MR, ten (40%) with functional MR, three (12%) with flail MV, one (4%) with MV prolapse and one (4%) with degenerative MR. EROA, regurgitant volume and regurgitant fraction were assessed using transthoracic 2D and 3D PISA methods. The quantitative Doppler EROA method and trans-thoracic VCW were used as reference methods.
Results:Both EROA and regurgitant volume assessed using the 3D PISA method had better correlations with the reference methods than conventional 2D PISA. A consistent significant underestimation of EROA and regurgitant volume using 2D PISA was observed. On the basis of the quantitative Doppler EROA method 14 patients had severe MR (EROA ≥ 0.4 cm2). Of these 14 patients, 78.5% (11 of 14) were underestimated as having non severe MR (EROA <0.4 cm2) by the 2D PISA method. In contrast, the 3D PISA method had 92.9% (13 of 14) agreement with The quantitative Doppler EROA method 14 patients had severe MR in classifying severe MR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.96 and 0.92, respectively.
Conclusion:Measurement of PISA without geometric assumptions using single-beat, real-time 3D color Doppler echocardiography is feasible in the clinical setting. MR quantification using this methodology is more accurate than the conventional 2D PISA method
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