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Impact of a Geometric Correction for Proximal Flow Constraint on the Assessment of Mitral Regurgitation Severity Using the Proximal Flow Convergence Method
Jeong Yoon Jang1*, Joon-Won Kang2, Dong Hyun Yang2, Sahmin Lee2, Byung Joo Sun3, Dae-Hee Kim2, Jong-Min Song2, Duk-Hyun Kang2, Jae-Kwan Song2*
1Division of Cardiology, Department of Internal Medicine Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National Uni
2Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine
3Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital
Corresponding Author: Jeong Yoon Jang ,Email: drjang80@naver.com
ABSTRACT
Background:
Overestimation of the severity of mitral regurgitation (MR) by the proximal convergence method (PISA) has been reported. We sought to test whether angle correction (AC) of the constrained flow field is helpful to eliminate overestimation in patients with eccentric MR. Methods and
Results:
In a total of 33 patients with MR due to prolapse or flail mitral valve, both echocardiography and cardiac magnetic resonance image (MRI) were performed to calculate regurgitant volume (RV). In addition to RV by conventional PISA (RVPISA), convergence angle (α) was measured from 2-dimensional Doppler color flow maps and RV was corrected by multiplying by α/180 (RVAC). RV measured by cardiac MRI (RVCMR)was used as a gold standard, which was calculated by the difference between total stroke volume measured by planimetry of the short axis slices and aortic stroke volume by phase-contrast image. The correlation between RVCMR and RV by echocardiography was modest and did not show any difference (RVCMR vs. RVPISA [r=0.712, p<0.001] and RVCMR vs. RVAC [r=0.766, p<0.001]). However, RVPISA showed significant overestimation (RVPISA - RVCMR = 50.6±40.6 vs. RVAC - RVCMR = 7.7±23.4 mL, p<0.001). The overall accuracy of RVPISA for diagnosis of severe MR, defined as RV≥60 mL, was 57.6% (19/33), whereas it increased to 84.8% (28/33) by using RVAC (p=0.028).
Conclusion:
Conventional PISA method tends to provide falsely large RV in patients with eccentric MR and a simple geometric angle correction of the proximal constraint flow largely eliminates overestimation.
Keywords: Mitral regurgitationm, Regurgitant volume, Proximal flow convergence, Echocardiography, Cardiac magnetic resonance image
Volume 26, No 1
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