TY - JOUR
T1 - Proximal Flow Convergence Region as Assessed by Real-time 3-Dimensional Echocardiography
T2 - Challenging the Hemispheric Assumption
AU - Yosefy, Chaim
AU - Levine, Robert A.
AU - Solis, Jorge
AU - Vaturi, Mordehay
AU - Handschumacher, Mark D.
AU - Hung, Judy
PY - 2007/4
Y1 - 2007/4
N2 - Objective: Traditionally, a hemispheric assumption for the proximal flow convergence region (PFCR) is used when calculating mitral regurgitant (MR) effective orifice area (EROA). However, 2-dimensional (2D) echocardiography limits evaluation of the complete PFCR contour. Real-time 3-dimensional (3D) echocardiography (RT3D) allows direct assessment of the true PFCR contour. We hypothesized that the PFCR contour is not necessarily hemispheric, but rather hemielliptic, and aimed to apply a hemielliptic calculation, based on the 3D contour of the PFCR for more accurate MR quantification. Methods: In all, 50 patients with MR underwent RT3D to characterize PFCR contour as hemispheric or hemielliptic. MR EROA by RT3D-derived PFCR was calculated using a hemielliptic formula using 3D data. The 2D EROA was computed using standard hemispheric assumption. EROAs calculated from 2D and RT3D data were compared with quantitative Doppler EROA (mitral inflow - aortic outflow/MR time-velocity integral), used as an independent comparison. Results: Only 1 of 50 patients (2%) had a hemispheric PFCR contour by RT3D. The remaining had hemielliptic PFCR contours. Compared with Doppler method, 2D echocardiography significantly underestimated EROA (0.34 ± 0.14 vs 0.48 ± 0.25 cm2, P < .001). RT3D EROA was not significantly different from Doppler EROA (0.52 ± 0.17 vs 0.48 ± 0.25, P = not significant). Of 33 patients with Doppler EROA greater than 0.3 cm2 (≥moderate-severe MR), 45% (15 of 33) were underestimated as having mild to moderate MR by 2D EROA. Conclusions: The true PFCR contour as shown by RT3D is generally not hemispheric but hemielliptic, tracking the orifice contour. Based on this 3D shape, a hemielliptic approach can be used for practical clinical application with improved MR quantification.
AB - Objective: Traditionally, a hemispheric assumption for the proximal flow convergence region (PFCR) is used when calculating mitral regurgitant (MR) effective orifice area (EROA). However, 2-dimensional (2D) echocardiography limits evaluation of the complete PFCR contour. Real-time 3-dimensional (3D) echocardiography (RT3D) allows direct assessment of the true PFCR contour. We hypothesized that the PFCR contour is not necessarily hemispheric, but rather hemielliptic, and aimed to apply a hemielliptic calculation, based on the 3D contour of the PFCR for more accurate MR quantification. Methods: In all, 50 patients with MR underwent RT3D to characterize PFCR contour as hemispheric or hemielliptic. MR EROA by RT3D-derived PFCR was calculated using a hemielliptic formula using 3D data. The 2D EROA was computed using standard hemispheric assumption. EROAs calculated from 2D and RT3D data were compared with quantitative Doppler EROA (mitral inflow - aortic outflow/MR time-velocity integral), used as an independent comparison. Results: Only 1 of 50 patients (2%) had a hemispheric PFCR contour by RT3D. The remaining had hemielliptic PFCR contours. Compared with Doppler method, 2D echocardiography significantly underestimated EROA (0.34 ± 0.14 vs 0.48 ± 0.25 cm2, P < .001). RT3D EROA was not significantly different from Doppler EROA (0.52 ± 0.17 vs 0.48 ± 0.25, P = not significant). Of 33 patients with Doppler EROA greater than 0.3 cm2 (≥moderate-severe MR), 45% (15 of 33) were underestimated as having mild to moderate MR by 2D EROA. Conclusions: The true PFCR contour as shown by RT3D is generally not hemispheric but hemielliptic, tracking the orifice contour. Based on this 3D shape, a hemielliptic approach can be used for practical clinical application with improved MR quantification.
UR - http://www.scopus.com/inward/record.url?scp=33947631386&partnerID=8YFLogxK
U2 - 10.1016/j.echo.2006.09.006
DO - 10.1016/j.echo.2006.09.006
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C2 - 17400118
AN - SCOPUS:33947631386
SN - 0894-7317
VL - 20
SP - 389
EP - 396
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 4
ER -