Quantitative Assessment of Mitral Regurgitation: Comparison Between Three-dimensional Transesophageal Echocardiography and Magnetic Resonance Imaging.

BACKGROUND: -Quantification of mitral regurgitation severity with 2-dimensional (2D) imaging techniques remains challenging. The present study compared the accuracy of 2D transesophageal echocardiography (TEE) and 3-dimensional (3D) TEE for quantification of mitral regurgitation, using magnetic resonance imaging (MRI) as reference method.

METHODS AND RESULTS: -2D and 3D TEE and cardiac MRI were performed in 30 patients with mitral regurgitation. Mitral effective regurgitant orifice area (EROA) and regurgitant volume (Rvol) were estimated with 2D and 3D TEE. With 3D TEE, EROA was calculated using planimetry of the color Doppler flow from "en face" views and Rvol was derived by multiplying the EROA by the velocity time integral of the regurgitant jet. Finally, using MRI mitral Rvol was quantified by subtracting the aortic flow volume from left ventricular stroke volume. Compared to 3D TEE, 2D TEE underestimated the EROA by a mean of 0.13 cm(2). In addition, 2D TEE underestimated the Rvol by 21.6% when compared to 3D TEE and by 21.3% when compared to MRI. In contrast, 3D TEE underestimated the Rvol by only 1.2% when compared to MRI. Finally, one third of the patients in grade 1 and >/=50% of the patients in grade 2 and 3, as assessed with 2D TEE, would have been upgraded to a more severe grade based on the 3D TEE and MRI measurements.

CONCLUSIONS: -Quantification of mitral EROA and Rvol with 3D TEE is feasible and accurate as compared to MRI and results in less underestimation of the Rvol as compared to 2D TEE.