Usefulness of Vena Contracta for Identifying Severe Secondary Mitral Regurgitation: A Three-Dimensional...

In secondary mitral regurgitation (SMR), effective regurgitant orifice area by the proximal isovelocity surface area method ( $$ ) evaluation might cause an underestimation of regurgitant orifice area because of its ellipticity compared with vena contracta area (VCA). We aimed to reassess the SMR severity using VCA-related parameters and $$ .

The three-dimensional transesophageal echocardiography data of 128 patients with SMR were retrospectively analyzed; the following parameters were evaluated: $$ , anteroposterior and mediolateral vena contracta widths (VCWs) of VCA (i.e., $$ and $$ ), $$ calculated as ( $$ + $$ )/2, and $$ calculated as $$ $$ ( $$ /2) $$ ( $$ /2). Severe SMR was defined as $$ 0.39 $$ .

The mean age of the patients was 77.0 $$ 8.9 years, and 78 (60.9%) were males. Compared with $$ (r = 0.801), $$ (r = 0.940) and $$ (r = 0.980) were strongly correlated with VCA. On receiver-operating characteristic curve analysis, $$ and $$ had C-statistics of 0.981 (95% confidence interval [CI], 0.963-1.000) and 0.985 (95% CI, 0.970-1.000), respectively; these were significantly higher than 0.910 (95% CI, 0.859-0.961) in $$ (p = 0.007 and p = 0.003, respectively). The best cutoff values for severe SMR of $$ and $$ were 0.78 cm and 0.42 $$ , respectively. The prevalence of severe SMR significantly increased with an increase in $$ (38 of 88 [43.2%] patients with $$ $$ 0.30 $$ , 21 of 24 [87.5%] patients with $$ = 0.30-0.40 $$ , and 16 of 16 [100%] patients with $$ $$ 0.40 $$ [Cochran-Armitage test; p $$ 0.001]). Among patients with $$ $$ 0.30 $$ , SMR severity based on VCA was accurately reclassified using $$ (McNemar's test; p = 0.505) and $$ (p = 0.182).

Among patients who had SMR with $$ of $$ 0.30 $$ , suggestive of moderate or less SMR according to current guidelines, $$ 40% had discordantly severe SMR based on VCA. $$ and $$ values were useful for identifying severe SMR based on VCA in these patients.