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Quantification of mitral regurgitation: comparison between transthoracic and transesophageal color Doppler flow
R Mimo1, L Sparacino, G Nicolosi
1Cardiologia, ARC, Ospedale Civile, Pordenone, Italy.
Insights
Transesophageal echocardiography (TEE) detects mitral regurgitation more often than transthoracic echocardiography (TTE), though quantitative measurements of jet areas are similar. TEE shows higher prevalence and severity estimates, but with significant variability.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Mitral regurgitation (MR) is a significant valvular heart disease.
- Accurate assessment of MR severity is crucial for patient management.
- Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) are key diagnostic tools.
Purpose of the Study:
- To compare the diagnostic performance of TTE and TEE in detecting and quantifying mitral regurgitation.
- To evaluate the concordance and discordance in severity grading between TTE and TEE.
- To assess the quantitative and semi-quantitative agreement between the two echocardiographic modalities.
Main Methods:
- Retrospective review of 100 consecutive patients undergoing both TTE and TEE.
- Assessment of mitral regurgitation presence and severity (mild, moderate, severe).
- Comparison of semi-quantitative grading and quantitative maximal jet areas between TEE and TTE.
Main Results:
- TEE identified mild mitral regurgitation in 26 patients where TTE was negative.
- Overall severity grading concordance was 64%; TEE showed higher grade in 35% vs. 1% for TTE.
- Maximal jet areas were similar (3.60 cm² TTE vs. 3.04 cm² TEE, P=NS), but TEE exhibited significant random variability.
Conclusions:
- TEE demonstrates a higher prevalence and tendency for greater semi-quantitative MR severity assessment compared to TTE.
- Quantitative assessment of maximal jet areas showed similar mean values but significant variability with TEE.
- While TEE offers improved detection, careful interpretation is needed due to observed variability in MR quantification.
Abstract:
We reviewed transthoracic (TTE) and transesophageal (TEE) echocardiograms of 100 consecutive patients: 63 male, 37 female, mean age 50 years (range 16-83 years), 32 with neoplastic disease, 18 aortic disease, 28 mitral valve disease, and 22 with other diseases. Absence or presence of mitral regurgitation (defined as mild, moderate, or severe) was assessed. TEE showed mild mitral regurgitation in 26 patients where TTE was negative. The overall estimate of regurgitant lesion severity was concordant at TEE and TTE in 64% of cases. The overall estimate of regurgitant lesion severity was also greater by one grade in 1% of cases at TTE, and in 35% of cases at TEE. Maximal digitized jet areas were 3.60 +/- 6.35 cm 2 at TTE and 3.04 +/- 3.79 cm 2 at TEE (P = NS). Correlation was r = 0.69 (TEE = 0.41 TTE + 1.55; P less than 0.001). TEE yielded a higher prevalence of mitral regurgitation than TTE with a trend toward greater overall estimate of mitral regurgitation at the semi-quantitative analysis. TTE and TEE showed similar mean results at the quantitative assessment of maximal jet areas. However, a highly significant random variability was observed in quantifying mitral regurgitation at TEE.