Sylvestre Maréchaux1, Caroline Le Goffic2, Pierre-Vladimir Ennezat3, Marc Semichon2, Anne-Laure Castel2, François Delelis2, Jean Michel Lemahieu2, Aymeric Menet2, Pierre Graux2, Christophe Tribouilloy4. 1. Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France INSERM U 1088 Université de Picardie, Amiens, France sylvestre.marechaux@yahoo.fr. 2. Cardiology Department, GCS-Groupement des Hôpitaux de L'Institut Catholique de Lille, Université Lille Nord de France, Service de cardiologie et soins intensifs, Faculté Libre de Médecine, Université Catholique de Lille, Rue du Grand But, 59160 Lomme, France. 3. Centre Hospitalier Universitaire de Grenoble, Grenoble, France. 4. INSERM U 1088 Université de Picardie, Amiens, France Centre Hospitalier Universitaire d'Amiens, Amiens, France.
Abstract
AIMS: To investigate the value of assessment of mitral regurgitant fraction (RF) using left ventricular (LV) volumes obtained by three-dimensional echocardiography (3DE) to quantify primary mitral regurgitation (MR). METHODS AND RESULTS: Sixty patients with primary MR in sinus rhythm were prospectively enrolled. RF was calculated using either 2DE or 3DE LV volumes obtained as follows: (LV total stroke volume - LV forward stroke volume by Doppler)/LV total stroke volume. Severity of MR was graded independently by two cardiologists blinded to LV volumetric data using an integrative approach, as recommended by current guidelines. Sixty patients with LV ejection fraction >50% and no MR were also studied. In patients without MR, 3D total LV stroke volume was more strongly correlated with LV forward stroke volume than 2D total LV stroke volume (r = 0.75, P < 0.0001 vs. r = 0.62, P < 0.0001, respectively). The 3D method had a feasibility of 90% in patients with MR. Inter-reader concordance for MR grading (four grades) was excellent with a Kappa-value of 0.90, P < 0.0001. A significant correlation was observed between grade of MR severity and 3D RF (r = 0.83, P < 0.0001) and 2D RF (r = 0.74, P < 0.0001). Comparisons between individual grades for 3D RF were significant (P < 0.05) except for 3+ vs. 4+ MR (P = 0.213). All patients with 3D RF ≥40% had ≥3+ or 4+ MR and those with 3D RF ≤30% had 1+ or 2+ MR with a 'grey' overlap zone between 30 and 40%. CONCLUSIONS: RF can be routinely determined using 3D LV volumes with a high feasibility in patients with primary MR and is reliable for identification of Grade 3+ or Grade 4+ MR. The incorporation of this parameter into the currently recommended multiparametric integrative approach might be helpful to discriminate significant MR. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To investigate the value of assessment of mitral regurgitant fraction (RF) using left ventricular (LV) volumes obtained by three-dimensional echocardiography (3DE) to quantify primary mitral regurgitation (MR). METHODS AND RESULTS: Sixty patients with primary MR in sinus rhythm were prospectively enrolled. RF was calculated using either 2DE or 3DE LV volumes obtained as follows: (LV total stroke volume - LV forward stroke volume by Doppler)/LV total stroke volume. Severity of MR was graded independently by two cardiologists blinded to LV volumetric data using an integrative approach, as recommended by current guidelines. Sixty patients with LV ejection fraction >50% and no MR were also studied. In patients without MR, 3D total LV stroke volume was more strongly correlated with LV forward stroke volume than 2D total LV stroke volume (r = 0.75, P < 0.0001 vs. r = 0.62, P < 0.0001, respectively). The 3D method had a feasibility of 90% in patients with MR. Inter-reader concordance for MR grading (four grades) was excellent with a Kappa-value of 0.90, P < 0.0001. A significant correlation was observed between grade of MR severity and 3D RF (r = 0.83, P < 0.0001) and 2D RF (r = 0.74, P < 0.0001). Comparisons between individual grades for 3D RF were significant (P < 0.05) except for 3+ vs. 4+ MR (P = 0.213). All patients with 3D RF ≥40% had ≥3+ or 4+ MR and those with 3D RF ≤30% had 1+ or 2+ MR with a 'grey' overlap zone between 30 and 40%. CONCLUSIONS: RF can be routinely determined using 3D LV volumes with a high feasibility in patients with primary MR and is reliable for identification of Grade 3+ or Grade 4+ MR. The incorporation of this parameter into the currently recommended multiparametric integrative approach might be helpful to discriminate significant MR. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Hacer Ceren Tokgöz; Cihangir Kaymaz; Selçuk Öztürk; Alper Özkan; Özgür Yaşar Akbal; Fatih Yılmaz; İbrahim Halil Tanboğa; Nihal Özdemir; Mehmet Mustafa Can Journal: Anatol J Cardiol Date: 2015-05 Impact factor: 1.596