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Quantification of mitral valve regurgitation by 2D and 3D echocardiography compared with cardiac magnetic resonance a systematic review and meta-analysis

Abstract

By means of systematic literature review and meta-analysis, we compared results of studies examining different echocardiographic methods assessing severity of mitral valve regurgitation volume (MVR) with cardiac magnetic resonance imaging (CMR) as standard reference. A systematic search of electronic databases revealed twenty studies eligible for meta-analysis. Results of 2D- and 3D-trans-thoracic (TTE) and trans-esophageal echocardiographic (TEE) proximal isovelocity surface area (PISA) and volumetric methods were compared with CMR. Mean differences (ml) with 95% limits of agreement (LoA) derived from Bland–Altman tests and correlations coefficients [(R) 95% confidence interval (CI)] were pooled together. Overall 1187 patients [mean age = 59 ± 13 years and 678(57%) males] with primary or secondary mild to severe MVR were included. Comparing all echocardiographic methods with CMR showed an overestimation and moderate agreement with difference and 95% LoA of 8.05(− 3.40, 19.49) ml, R = 0.73(95% CI 0.71–0.76) p < 0.001. 3D-PISA followed by 3D-volumetric methods showed the better agreement with an underestimation of − 3.20(− 12.33, 5.92) ml, R = 0.84(95% CI 0.78–0.89) p < 0.001 and overestimation of 3.73(− 9.17, 16.61) ml, R = 0.90(95% CI 0.87, 0.94) p < 0.001, respectively. 2D-volumetric method showed the poorest agreement with difference and 95% LoA of 23.56(− 4.19, 51.31) ml, R = 0.64(95% CI 0.54–0.73) p < 0.001. In patients (n = 280) with severe MVR, 2D technique incorrectly estimated regurgitation volume severity in 106 (38%) compared to 4(14%) patients using 3D technique. Among echocardiographic methods 3D-PISA agreed best with CMR as reference, making 3D-PISA the most reliable method to quantify MVR. CMR can be considered in severe MVR where uncertainties arise and a decision-making prior valve surgery is required. Further powerful studies are needed to assess the accuracy of different echocardiographic methods.

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References

  1. 1.

    Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, Forouzanfar MH, Longenecker CT, Mayosi BM, Mensah GA, Nascimento BR, Ribeiro ALP, Sable CA, Steer AC, Naghavi M, Mokdad AH, Murray CJL, Vos T, Carapetis JR, Roth GA (2017) Global, regional, and national burden of rheumatic heart disease, 1990-2015. N Engl J Med 377(8):713–722. https://doi.org/10.1056/NEJMoa1603693

  2. 2.

    Rosenhek R, Rader F, Klaar U, Gabriel H, Krejc M, Kalbeck D, Schemper M, Maurer G, Baumgartner H (2006) Outcome of watchful waiting in asymptomatic severe mitral regurgitation. Circulation 113(18):2238–2244. https://doi.org/10.1161/circulationaha.105.599175

  3. 3.

    Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Munoz D, Rosenhek R, Sjogren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, Group ESCSD (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791. https://doi.org/10.1093/eurheartj/ehx391

  4. 4.

    Shanks M, Siebelink H-MJ, Delgado V, van de Veire NRL, Ng ACT, Sieders A, Schuijf JD, Lamb HJ, Marsan NA, Westenberg JJM, Kroft LJ, de Roos A, Bax JJ (2010) Quantitative assessment of mitral regurgitation comparison between three-dimensional transesophageal echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging 3(6):694–700. https://doi.org/10.1161/circimaging.110.947176

  5. 5.

    Thavendiranathan P, Liu S, Datta S, Rajagopalan S, Ryan T, Igo SR, Jackson MS, Little SH, De Michelis N, Vannan MA (2013) Quantification of chronic functional mitral regurgitation by automated 3-dimensional peak and integrated proximal isovelocity surface area and stroke volume techniques using real-time 3-dimensional volume color Doppler echocardiography in vitro and clinical validation. Circ Cardiovasc Imaging 6(1):125–133. https://doi.org/10.1161/circimaging.112.980383

  6. 6.

    Krieger EV, Lee J, Branch KR, Hamilton-Craig C (2016) Quantitation of mitral regurgitation with cardiac magnetic resonance imaging: a systematic review. Heart (British Cardiac Society) 102(23):1864–1870. https://doi.org/10.1136/heartjnl-2015-309054

  7. 7.

    Uretsky S, Argulian E, Narula J, Wolff SD (2018) Use of cardiac magnetic resonance imaging in assessing mitral regurgitation: current evidence. J Am Coll Cardiol 71(5):547–563. https://doi.org/10.1016/j.jacc.2017.12.009

  8. 8.

    Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, Group P-P (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1. https://doi.org/10.1186/2046-4053-4-1

  9. 9.

    Thavendiranathan P, Phelan D, Collier P, Thomas JD, Flamm SD, Marwick TH (2012) Quantitative assessment of mitral regurgitation: how best to do it. JACC Cardiovasc Imaging 5(11):1161–1175. https://doi.org/10.1016/j.jcmg.2012.07.013

  10. 10.

    Brugger N, Wustmann K, Huerzeler M, Wahl A, de Marchi SF, Steck H, Zuercher F, Seiler C (2015) Comparison of three-dimensional proximal isovelocity surface area to cardiac magnetic resonance imaging for quantifying mitral regurgitation. Am J Cardiol 115(8):1130–1136. https://doi.org/10.1016/j.amjcard.2015.01.550

  11. 11.

    Harris AW, Krieger EV, Kim M, Cawley PJ, Owens DS, Hamilton-Craig C, Maki J, Otto CM (2017) Cardiac magnetic resonance imaging versus transthoracic echocardiography for prediction of outcomes in chronic aortic or mitral regurgitation. Am J Cardiol 119(7):1074–1081. https://doi.org/10.1016/j.amjcard.2016.12.017

  12. 12.

    Cawley PJ, Hamilton-Craig C, Owens DS, Krieger EV, Strugnell WE, Mitsumori L, D’Jang CL, Schwaegler RG, Nguyen KQ, Nguyen B, Maki JH, Otto CM (2013) Prospective comparison of valve regurgitation quantitation by cardiac magnetic resonance imaging and transthoracic echocardiography. Circ Cardiovasc Imaging 6(1):48–57. https://doi.org/10.1161/circimaging.112.975623

  13. 13.

    Van De Heyning CM, Magne J, Pierard LA, Bruyere P-J, Davin L, De Maeyer C, Paelinck BP, Vrints CJ, Lancellotti P (2013) Assessment of left ventricular volumes and primary mitral regurgitation severity by 2D echocardiography and cardiovascular magnetic resonance. Cardiovasc Ultrasound. https://doi.org/10.1186/1476-7120-11-46

  14. 14.

    Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8(2):135–160. https://doi.org/10.1177/096228029900800204

  15. 15.

    Williamson PR, Lancaster GA, Craig JV, Smyth RL (2002) Meta-analysis of method comparison studies. Stat Med 21(14):2013–2025. https://doi.org/10.1002/sim.1158

  16. 16.

    Kizilbash AM, Hundley WG, Willett DL, Franco F, Peshock RM, Grayburn PA (1998) Comparison of quantitative Doggler with magnetic resonance imaging for assessment of the severity of mitral regurgitation. Am J Cardiol 81(6):792–795. https://doi.org/10.1016/s0002-9149(97)01024-2

  17. 17.

    Lopez-Mattei JC, Ibrahim H, Shaikh KA, Little SH, Shah DJ, Maragiannis D, Zoghbi WA (2016) Comparative assessment of mitral regurgitation severity by transthoracic echocardiography and cardiac magnetic resonance using an integrative and quantitative approach. Am J Cardiol 117(2):264–270. https://doi.org/10.1016/j.amjcard.2015.10.045

  18. 18.

    Penicka M, Vecera J, Mirica DC, Kotrc M, Kockova R, van Camp G (2018) Prognostic implications of magnetic resonance-derived quantification in asymptomatic patients with organic mitral regurgitation comparison with Doppler echocardiography-derived integrative approach. Circulation 137(13):1349–1360. https://doi.org/10.1161/circulationaha.117.029332

  19. 19.

    Sachdev V, Hannoush H, Sidenko S, Saba SG, Sears-Rogan P, Bandettini WP, Brofferio A, Shanbhag SM, Brenneman CL, Horvath KA, Waclawiw MA, Arai AE (2017) Are echocardiography and CMR really discordant in mitral regurgitation? JACC Cardiovasc Imaging 10(7):823–824. https://doi.org/10.1016/j.jcmg.2016.08.007

  20. 20.

    Uretsky S, Gillam L, Lang R, Chaudhry FA, Argulian E, Supariwala A, Gurram S, Jain K, Subero M, Jang JJ, Cohen R, Wolff SD (2015) Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity a prospective multicenter trial. J Am Coll Cardiol 65(11):1078–1088. https://doi.org/10.1016/j.jacc.2014.12.047

  21. 21.

    Levy F, Marechaux S, Iacuzio L, Schouver ED, Castel AL, Toledano M, Rusek S, Dor V, Tribouilloy C, Dreyfus G (2018) Quantitative assessment of primary mitral regurgitation using left ventricular volumes obtained with new automated three-dimensional transthoracic echocardiographic software: a comparison with 3-Tesla cardiac magnetic resonance. Arch Cardiovasc Dis 111(8–9):507–517. https://doi.org/10.1016/j.acvd.2017.10.008

  22. 22.

    Buck T, Plicht B, Kahlert P, Schenk IM, Hunold P, Erbel R (2008) Effect of dynamic flow rate and orifice area on mitral regurgitant stroke volume quantification using the proximal isovelocity surface area method. J Am Coll Cardiol 52(9):767–778. https://doi.org/10.1016/j.jacc.2008.05.028

  23. 23.

    Hamada S, Altiok E, Frick M, Almalla M, Becker M, Marx N, Hoffmann R (2012) Comparison of accuracy of mitral valve regurgitation volume determined by three-dimensional transesophageal echocardiography versus cardiac magnetic resonance imaging. Am J Cardiol 110(7):1015–1020. https://doi.org/10.1016/j.amjcard.2012.05.037

  24. 24.

    Myerson SG, d’Arcy J, Christiansen JP, Dobson LE, Mohiaddin R, Francis JM, Prendergast B, Greenwood JP, Karamitsos TD, Neubauer S (2016) Determination of clinical outcome in mitral regurgitation with cardiovascular magnetic resonance quantification. Circulation 133(23):2287–2296. https://doi.org/10.1161/circulationaha.115.017888

  25. 25.

    Shimada YJ, Shiota M, Siegel RJ, Shiota T (2010) Accuracy of right ventricular volumes and function determined by three-dimensional echocardiography in comparison with magnetic resonance imaging: a meta-analysis study. J Am Soc Echocardiogr 23(9):943–953. https://doi.org/10.1016/j.echo.2010.06.029

  26. 26.

    Matsumura Y, Saracino G, Sugioka K, Tran H, Greenberg NL, Wada N, Toyono M, Fukuda S, Hozumi T, Thomas JD, Yoshikawa J, Yoshiyama M, Shiota T (2008) Determination of regurgitant orifice area with the use of a new three-dimensional flow convergence geometric assumption in functional mitral regurgitation. J Am Soc Echocardiogr 21(11):1251–1256. https://doi.org/10.1016/j.echo.2008.09.004

  27. 27.

    Choi J, Heo R, Hong G-R, Chang H-J, Sung JM, Shin SH, Cho IJ, Shim C-Y, Chung N (2014) Differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation according to the severity and characteristics. Circ Cardiovasc Imaging 7(3):535–544. https://doi.org/10.1161/circimaging.113.001457

  28. 28.

    Marsan NA, Westenberg JJM, Ypenburg C, Delgado V, van Bommel RJ, Roes SD, Nucifora G, van der Geest RJ, de Roos A, Reiber JC, Schalij MJ, Bax JJ (2009) Quantification of functional mitral regurgitation by real-time 3D echocardiography comparison with 3D velocity-encoded cardiac magnetic resonance. JACC Cardiovasc Imaging 2(11):1245–1252. https://doi.org/10.1016/j.jcmg.2009.07.006

  29. 29.

    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ, American Society of E (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16(7):777–802. https://doi.org/10.1016/S0894-7317(03)00335-3

  30. 30.

    Plicht B, Kahlert P, Goldwasser R, Janosi R-A, Hunold P, Erbel R, Buck T (2008) Direct quantification of mitral regurgitant flow volume by real-time three-dimensional echocardiography using dealiasing of color Doppler flow at the vena contracta. J Am Soc Echocardiogr 21(12):1337–1346. https://doi.org/10.1016/j.echo.2008.09.022

  31. 31.

    Skaug TR, Hergum T, Amundsen BH, Skjaerpe T, Torp H, Haugen BO (2010) Quantification of mitral regurgitation using high pulse repetition frequency three-dimensional color Doppler. J Am Soc Echocardiogr 23(1):1–8. https://doi.org/10.1016/j.echo.2009.10.005

  32. 32.

    Son J-W, Chang H-J, Lee J-K, Chung H-J, Song R-Y, Kim Y-J, Datta S, Heo R, Shin S-H, Cho I-J, Shim CY, Hong G-R, Chung N (2013) Automated quantification of mitral regurgitation by three dimensional real time full volume color Doppler transthoracic echocardiography: a validation with cardiac magnetic resonance imaging and comparison with two dimensional quantitative methods. J Cardiovasc Ultrasound 21(2):81–89. https://doi.org/10.4250/jcu.2013.21.2.81

  33. 33.

    Aplin M, Kyhl K, Bjerre J, Ihlemann N, Greenwood JP, Plein S, Uddin A, Tonder N, Host NB, Ahlstrom MG, Hove J, Hassager C, Iversen K, Vejlstrup NG, Madsen PL (2016) Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 17(8):863–870. https://doi.org/10.1093/ehjci/jev321

  34. 34.

    Heo R, Son JW, Oh B, Chang HJ, Kim YJ, Datta S, Cho IJ, Shim CY, Hong GR, Ha JW, Chung N (2017) Clinical implications of three-dimensional real-time color Doppler transthoracic echocardiography in quantifying mitral regurgitation: a comparison with conventional two-dimensional methods. J Am Soc Echocardiogr 30(4):393–403.e397. https://doi.org/10.1016/j.echo.2016.12.010

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This study was not funded by any source.

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Correspondence to Jawdat Abdulla.

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Jawdat Abdulla has received speaker fees from Novartis Health Care. All the other authors declared that they have no conflict of interest.

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Sköldborg, V., Madsen, P.L., Dalsgaard, M. et al. Quantification of mitral valve regurgitation by 2D and 3D echocardiography compared with cardiac magnetic resonance a systematic review and meta-analysis. Int J Cardiovasc Imaging 36, 279–289 (2020). https://doi.org/10.1007/s10554-019-01713-7

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Keywords

  • Mitral regurgitation
  • Echocardiography
  • Magnetic resonance