Calculation of Regurgitant Volume Using Echocardiographic Volumetric Method for Accurate Diagnosis of Severe Mitral Regurgitation.
Ga Yun Kim, Ha Hye Jo, So-Min Lim, Dayoung Pack, Hye Soo Lee, Jong En Lee, Hyun Jung Koo, Ji Sung Lee, Sahmin Lee, Byung Joo Sun, Dae-Hee Kim, Jong-Min Song, Duk-Hyun Kang, Jae-Kwan Song
Author Information
Ga Yun Kim: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Ha Hye Jo: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
So-Min Lim: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Dayoung Pack: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Hye Soo Lee: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jong En Lee: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Hyun Jung Koo: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Ji Sung Lee: Clinical Research Center, Asan Institute for Life Science, Seoul, South Korea.
Sahmin Lee: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Byung Joo Sun: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Dae-Hee Kim: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jong-Min Song: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Duk-Hyun Kang: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Jae-Kwan Song: Department of Cardiology and Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. Electronic address: jksong@amc.seoul.kr.
OBJECTIVES: To evaluate the accuracy of regurgitant volume calculated by volumetric transthoracic echocardiography (RegVol_) for diagnosing severe primary mitral regurgitation (MR). BACKGROUND: Recent studies have shown suboptimal results of the proximal isovelocity surface area (PISA) method and the American Society of Echocardiography (ASE) algorithm for diagnosing severe primary MR. METHODS: A total of 74 patients with primary MR due to prolapse or flail leaflet were prospectively recruited for both TTE and cardiac magnetic resonance imaging (CMR). RegVol was calculated using PISA (RegVol_) or the volumetric method (left ventricular total stroke volume-systolic forward outflow volume; RegVol_). According to the ASE algorithm, patients with four or more parameters were diagnosed with severe MR. RegVol_ of ≥60 mL was used as the gold standard for diagnosing severe MR. RESULTS: All subjects had at least moderate to severe MR based on ASE guidelines. CMR confirmed that 30 patients (41%) had severe MR. The concordance correlation coefficient between RegVol_ and RegVol_ (0.809; 95% confidence interval [CI], 0.715-0.893) was higher than that between RegVol_ and RegVol_ (0.468; 95% CI, 0.323-0.576). The overall accuracy of RegVol_ for the diagnosis of severe MR was 90.5% (95% CI, 81.5-96.1), which was significantly higher than that of RegVol_ (64.9%; 95% CI, 52.9-75.6; p<0.001) and the ASE algorithm (77.0%; 95% CI, 65.8-86.0; p=0.004). The area under the curve of RegVol_ (0.95; 95% CI, 0.90-1.00) was significantly larger than that of RegVol_ (0.88; 95% CI, 0.80-0.96; p=0.028). CONCLUSIONS: RegVol_ showed better diagnostic performance than the PISA method and the ASE algorithm in diagnosing severe MR. Further investigations are necessary to evaluate the clinical usefulness of routine utilization of RegVol_.
