Quantification of Functional Mitral Regurgitation by Real-Time 3D EchocardiographyComparison With 3D Velocity-Encoded Cardiac Magnetic Resonance
Nina Ajmone Marsan, MD*, ,
Jos J.M. Westenberg, PhD ,
Claudia Ypenburg, MD*,
Victoria Delgado, MD*,
Rutger J. van Bommel, MD*,
Stijntje D. Roes, MD ,
Gaetano Nucifora, MD*,
Rob J. van der Geest, PhD,
Albert de Roos, MD, PhD,
Johan C. Reiber, PhD,
Martin J. Schalij, MD, PhD*,
Jeroen J. Bax, MD, PhD*,*
* Departments of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
IRCCS Policlinico S. Matteo, Pavia, Italy
View larger version (31K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 1 Reformat Procedure of Mitral Valve Flow From 3D 3-Directional VE-CMR Data
Schematic representation of reformat procedure of mitral valve flow from 3-dimensional (3D) 3-directional velocity-encoded cardiac magnetic resonance (VE-CMR) data. The acquisition is performed in a volume positioned at the basal level of the heart (left), covering the full excursion of the mitral valve during contraction and relaxation. From the 3D velocity vector field, the trans-mitral flow is retrospectively quantified by multi-planar reformatting of mitral valve in 2- (2CH) and 4-chamber (4CH) views (second panel). The through-plane velocity is constructed from the dot product with the normal vector (third panel). During systole, regurgitant flow can be identified and quantified. During diastole, mitral valve inflow is acquired. Through-plane motion correction is performed from the longitudinal velocity measured in the lateral wall (green lines). The regurgitant volume was obtained by calculating the Riemann sum of backward flow during systole in the flow graph (right panel).
|
|
View larger version (49K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 2 Real-Time 3D Echocardiographic Technique for Assessment of Vena Contracta Area (EROA-3D)
The 3-dimensional (3D) dataset is manually cropped by an image plane perpendicularly oriented to the jet direction up to the narrowest cross-sectional area of the jet. Effective regurgitant orifice area (EROA)-3D is measured by manual planimetry of the color Doppler signal tilting the image in an "en face" view. (A) Example of a patient with moderate functional mitral regurgitation (MR) and asymmetric EROA-3D (= 0.23 cm2) elongated along the leaflet coaptation line. (B) Example of a patient with severe functional MR and extremely irregular EROA-3D (= 0.48 cm2), for which geometric assumptions might not be applicable.
|
|
View larger version (14K):
[in this window]
[in a new window]
[Download PPT slide]
|
Figure 3 Comparison Between Mitral Rvol Assessed With RT3DE (Rvol-3D) and by 3-Directional Velocity-Encoded CMR (Rvol-CMR)
(A) Correlation between mitral regurgitant volume (Rvol) assessed with real-time 3-dimensional echocardiography (RT3DE) (Rvol-3D) and by 3-directional velocity-encoded cardiac magnetic resonance (CMR) (Rvol-CMR). (B) Bland-Altman scatter plot of differences in Rvol between RT3DE and CMR and the average Rvol between the 2 techniques: Rvol-3D is 0.08 ml/beat lower than Rvol-CMR (p = 0.87), limits of agreement from –7.7 to 7.6 ml/beat.
|
|
|
