Two-dimensional echocardiographic evaluation of mitral valve calcification. Sensitivity and specificity

The effectiveness of two-dimensional echocardiography in assessing mitral valve calcification was compared to radiography of the surgically excised valves in 43 patients affected by rheumatic disease of the mitral valve. Mitral valve calcification was graded as absent or present if single thin or multiple dense conglomerate echoes defined the valvular orifice in short axis view, provided the sensitivity of the instrumentation was adequately optimized. The radiograph of the excised valve was similarly graded. The interobserver reproducibility for both two-dimensional echocardiography and radiography was 100 percent. There were 14 true positives, 19 true negatives, 10 false positives and no false negatives, thus giving, for two-dimensional echocardiography, a sensitivity of 100 percent and a specificity of 65 per cent. It is concluded that two-dimensional echocardiography is an extremely sensitive method for assessing mitral valve calcification, and is prospectively useful also in planning reconstruction versus replacement in mitral valve surgery. Nevertheless, the consistent number of false positives affecting two-dimensional echocardiography represents a definite limit to the specificity of the technique.