Differential effect of 3-dimensional color doppler echocardiography for the quantifcation of mitral regurgitation according to the severity and characteristics

Background-The aim of this study is to explore the differential effect of 3-dimensional color Doppler echocardiography for the quantifcation of mitral regurgitation (MR). Two-dimensional color Doppler echocardiography-based MR quantifcation has well-documented limitations. Methods and Results-We consecutively enrolled 221 patients with MR. Adequate image quality was obtained by 2D- and 3D-color Doppler echocardiography in 211 (95.5%) patients. The quantitative differences between the MR volumes obtained by 2D- and 3D-proximal isovelocity surface area (PISA) were analyzed in various MR subgroups. In the validation cohort (n=52), MR volume obtained by 3D-PISA showed a better agreement with phase-contrast cardiac MRI than 2D-PISA (r=0.97 versus 0.84). In all 211 patients, 2D-PISA underestimated the MR volume when compared with 3D-PISA (52.4±19.6 versus 59.5±25.6 mL; P=0.005). A total of 33.3% with severe MR based on 3D-PISA were incorrectly assessed by 2D-PISA as having nonsevere MR. In the subgroup analysis, the MR severity (odds ratio, 6.96; 95% confdence interval, 3.04-15.94; P<0.001) and having an asymmetrical orifce (odds ratio, 11.48; 95% confdence interval, 3.72-35.4; P<0.001), and an eccentric jet (odds ratio, 3.82; 95% confdence interval, 1.27-11.48; P=0.017) were predictors of signifcant difference in MR volume (>15 mL) between 2D- and 3D-PISA methods. Conclusions-Quantifcation of MR by 3D-PISA method is clinically feasible and more accurate than the current 2D-PISA method. MR quantifcation by 2D-PISA signifcantly underestimated MR volume with severe, eccentric MR with an asymmetrical orifce. This article demonstrates that 3D-color Doppler echocardiography could be used as a valuable tool to confrm treatment strategy in patients with signifcant MR.