[Current recommendations on echocardiographic evaluation of the severity of mitral regurgitation: standardization and...

Besides diagnosis of the mechanism of mitral regurgitation accurate evaluation of the severity is of critical importance for the assessment of prognosis and planning of therapy. Current recommendations are differentiating two levels of evaluation of severity, (1) a rapid, basic evaluation, and (2) an extended, quantitative evaluation. In the present article the following modified practically applicable system for evaluation and scoring of severity of mitral regurgitation is proposed: step 1: color Doppler jet size: < 4 cm(2) or < 20% of left atrium (LA; = 1 scoring point), 4-8 cm2 or 20-40% of LA (2 points), > 8 cm(2) or > 40% of LA (3 points); step 2: central jet (1 point), eccentric/wall jet (2 points); step 3: LA width: 4 cm (2 points); step 4: proximal jet width: < 0,3 cm (1 point), 0,3-0,7 cm (3 points), > 0,7 cm (5 points). Grades of severity are scored as follows: grade I = 4-5 points, I-II = 6 points, II = 7-8 points, II-III = 9 points, III = 10-12 points. Quantitative Doppler method and PISA (proximal isovelocity surface area) method can be used for calculation of regurgitant volume and effective regurgitant orifice area (EROA), but recommendations for routine application are limited due to indirect measurements and inaccurate hemodynamic assumptions. Special techniques like real-time 3-D echocardiography, quantitative spectral Doppler analysis or stress echocardiographic assessment of severity are still under scientific evaluation. Due to the growing possibilities of early reconstruction of the mitral valve and catheter-based interventional annulus reconstructions, more accurate methods for direct quantification of regurgitant flow will be demanded in the future.