Calculation of Regurgitant Volume Using Echocardiographic Volumetric Method for Accurate Diagnosis of Severe Mitral Regurgitation

• Published in: Journal of the American Society of Echocardiography Vol. 38; no. 8; pp. 671 - 681
• Main Authors: Kim, Ga Yun, Jo, Ha Hye, Lim, So-Min, Pack, Dayoung, Lee, Hye Soo, Lee, Jong En, Koo, Hyun Jung, Lee, Ji Sung, Lee, Sahmin, Sun, Byung Joo, Kim, Dae-Hee, Song, Jong-Min, Kang, Duk-Hyun, Song, Jae-Kwan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2025
• Subjects: Aged; Algorithms; Cardiac magnetic resonance imaging; Cardiovascular; Echocardiography; Echocardiography - methods; Echocardiography, Three-Dimensional - methods; Female; Humans; Male; Middle Aged; Mitral regurgitation; Mitral Valve - diagnostic imaging; Mitral Valve - physiopathology; Mitral Valve Insufficiency - diagnosis; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - physiopathology; Prospective Studies; Regurgitant volume; Reproducibility of Results; Sensitivity and Specificity; Severity of Illness Index; Stroke Volume - physiology; Volumetry; PISA; Echocardiography; TTE; MR; CMR; LV; Regurgitant volume; 2D; ASE; RegVol; Volumetry; Mitral regurgitation; Cardiac magnetic resonance imaging; Transthoracic echocardiography; Two-dimensional; Left ventricular; Proximal isovelocity surface area; Mitral regurgitant volume; Cardiac magnetic resonance; American Society of Echocardiography
• ISSN: 0894-7317; 1097-6795; 1097-6795
• DOI: 10.1016/j.echo.2025.02.012

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 mitral regurgitation (MR). The aim of this study was to evaluate the accuracy of regurgitant volume (RegVol) calculated using volumetric transthoracic echocardiography (TTE) for diagnosing severe primary MR. A total of 74 patients with primary MR due to prolapse or flail leaflet were prospectively recruited for both TTE and cardiac magnetic resonance (CMR) imaging. RegVol was calculated using PISA (RegVol_PISA) or the volumetric method (left ventricular total stroke volume − systolic forward outflow volume; RegVol_TTE). According to the ASE algorithm, patients with four or more parameters were diagnosed with severe MR. RegVol_CMR ≥ 60 mL was used as the gold standard for diagnosing severe MR. All subjects had at least moderate to severe MR according to ASE guidelines. CMR imaging confirmed that 30 patients (41%) had severe MR. The concordance correlation coefficient between RegVol_TTE and RegVol_CMR (0.809; 95% CI, 0.715-0.893) was higher than that between RegVol_PISA and RegVol_CMR (0.468; 95% CI, 0.323-0.576). The overall accuracy of RegVol_TTE for the diagnosis of severe MR was 90.5% (95% CI, 81.5-96.1), which was significantly higher than that of RegVol_PISA (64.9%; 95% CI, 52.9-75.6; P < .001) and the ASE algorithm (77.0%; 95% CI, 65.8-86.0; P = .004). The area under the curve for RegVol_TTE (0.95; 95% CI, 0.90-1.00) was significantly larger than that for RegVol_PISA (0.88; 95% CI, 0.80-0.96; P = .028). RegVol_TTE 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 the routine use of RegVol_TTE. Calculation of RegVol using echocardiographic volumetric method for accurate diagnosis of severe primary degenerative MR. This head-to-head comparison of the PISA technique, ASE algorithm, and volumetric TTE using CMR imaging as a gold standard showed that the calculation of RegVol using echocardiographic volumetric method is more accurate than the PISA method and the ASE algorithm, with the largest area under the curve (AUC) on the receiver operating characteristic curve analysis. EF, Ejection fraction; LA, left atrial; LV, left ventricle; VCW, vena contracta width. [Display omitted] •RegVol can be calculated using a 2D volumetric echocardiographic method.•This method was more accurate than the PISA method in diagnosing severe primary MR.•Further investigations are needed to evaluate the clinical usefulness of this method.