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Three-dimensional proximal flow convergence automatic calculation for determining mitral valve area in rheumatic
Francisco Sampaio1,2, Ricardo Ladeiras-Lopes1,2, João Almeida1
1Cardiology Department, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal.
Echocardiography (Mount Kisco, N.Y.)
|May 19, 2017
Summary
Three-dimensional proximal isovelocity surface area (3D PISA) echocardiography accurately estimates mitral valve area (MVA) in mitral stenosis patients. This method is more precise than traditional two-dimensional (2D) techniques, offering improved clinical utility.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Accurate mitral valve area (MVA) quantification is crucial for managing mitral stenosis (MS).
- Current two-dimensional (2D) echocardiographic methods for MVA estimation have inherent limitations.
- Three-dimensional (3D) echocardiography offers potential to overcome these limitations.
Purpose of the Study:
- To evaluate the accuracy of 3D direct measurement of proximal isovelocity surface area (PISA) for MVA estimation in MS patients.
- To compare the accuracy of 3D PISA with established 2D echocardiographic methods.
Main Methods:
- Prospective study of 27 rheumatic MS patients undergoing 2D and 3D echocardiography.
- Reference MVA quantification by valve planimetry using 3D-volume multiplanar reconstruction.
- Semi-automated software used for 3D flow convergence volume calculation.
Main Results:
- 3D PISA demonstrated the best correlation with 3D planimetry (rho=0.78, P<.0001) for MVA estimation.
- Bland-Altman analysis showed good agreement for 3D PISA (mean difference -0.03 cm², LOA -0.40-0.35).
- 2D methods (CE, PHT, 2D PISA) exhibited wider limits of agreement compared to 3D PISA.
Conclusions:
- 3D PISA is a feasible and more accurate method for MVA estimation in MS compared to 2D techniques.
- 3D PISA can potentially overcome the technical limitations associated with 2D MVA quantification.
- The integration of 3D PISA into routine clinical practice is suggested.
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