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Automatic quantification of aortic regurgitation using 3D full volume color doppler echocardiography: a validation study with cardiac magnetic resonance imaging

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Abstract

Recent advances in real-time three-dimensional (3D) echocardiography provide the automated measurement of mitral inflow and aortic stroke volume without the need to assume the geometry of the heart. The aim of this study is to explore the ability of 3D full volume color Doppler echocardiography (FVCDE) to quantify aortic regurgitation (AR). Thirty-two patients with more than a moderate degree of AR were enrolled. AR volume was measured by (1) two-dimensional-CDE, using the proximal isovelocity surface area (PISA) and (2) real-time 3D-FVCDE with (3) phase-contrast cardiac magnetic resonance imaging (PC-CMR) as the reference method. Automated AR quantification using 3D-FVCDE was feasible in 30 of the 32 patients. 2D-PISA underestimated the AR volume compared to 3D-FVCDE and PC-CMR (38.6 ± 9.9 mL by 2D-PISA; 49.5 ± 10.2 mL by 3D-FVCDE; 52.3 ± 12.6 mL by PC-CMR). The AR volume assessed by 3D-FVCDE showed better correlation and agreement with PC-CMR (r = 0.93, p < 0.001, 2SD: 9.5 mL) than did 2D-PISA (r = 0.76, p < 0.001, 2SD: 15.7 mL). When used to classify AR severity, 3D-FVCDE agreed better with PC-CMR (k = 0.94) than did 2D-PISA (k = 0.53). In patients with eccentric jets, only 30 % were correctly graded by 2D-PISA. Conversely, almost all patients with eccentric jets (86.7 %) were correctly graded by 3D-FVCDE. In patients with multiple jets, only 3 out of 10 were correctly graded by 2D-PISA, while 3D-FVCDE correctly graded 9 out of 10 of these patients. Automated quantification of AR using the 3D-FVCDE method is clinically feasible and more accurate than the current 2D-based method. AR quantification by 2D-PISA significantly misclassified AR grade in patients with eccentric or multiple jets. This study demonstrates that 3D-FVCDE is a valuable tool to accurately measure AR volume regardless of AR characteristics.

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Abbreviations

AR:

Aortic regurgitation

PISA:

Proximal isovelocity surface area

FVCDE:

Full volume color Doppler echocardiography

2D:

Two dimension/dimensional

3D:

Three dimension/dimensional

EROA:

Effective regurgitant orifice area

PC-CMR:

Phase-contrast cardiac magnetic resonance imaging

RVol:

Regurgitant volume

References

  1. Bonow RO, Carabello BA, Chatterjee K et al (2008) 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task force on practice guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52(13):e1–142

    Article  PubMed  Google Scholar 

  2. Vahanian A, Alfieri O, Andreotti F et al (2012) Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 33(19):2451–2496

    Article  PubMed  Google Scholar 

  3. Lancellotti P, Tribouilloy C, Hagendorff A et al (2010) European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr 11(3):223–244

    Article  PubMed  Google Scholar 

  4. Zoghbi WA, Enriquez-Sarano M, Foster E et al (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 16(7):777–802

    Article  PubMed  Google Scholar 

  5. Lancellotti P, Moura L, Pierard LA et al (2010) European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 11(4):307–332

    Article  PubMed  Google Scholar 

  6. Pouleur AC, le de Waroux JBP, Goffinet C et al (2008) Accuracy of the flow convergence method for quantification of aortic regurgitation in patients with central versus eccentric jets. Am J Cardiol 102(4):475–480

    Article  PubMed  Google Scholar 

  7. Pirat B, Little SH, Igo SR et al (2009) Direct measurement of proximal isovelocity surface area by real-time three-dimensional color Doppler for quantitation of aortic regurgitant volume: an in vitro validation. J Am Soc Echocardiogr 22(3):306–313

    Article  PubMed Central  PubMed  Google Scholar 

  8. Son JW, Chang HJ, Lee JK et al (2013) Automated quantification of mitral regurgitation by three dimensional real time full volume color Doppler transthoracic echocardiography: a validation with cardiac magnetic resonance imaging and comparison with two dimensional quantitative methods. J Cardiovasc Ultrasound 21(2):81–89

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lang RM, Badano LP, Tsang W et al (2012) EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 13(1):1–46

    Article  PubMed  Google Scholar 

  10. Muraru D, Badano LP, Vannan M, Iliceto S (2012) Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice. Eur Heart J Cardiovasc Imaging 13(7):541–555

    Article  PubMed  Google Scholar 

  11. Lodato JA, Weinert L, Baumann R et al (2007) Use of 3-dimensional color Doppler echocardiography to measure stroke volume in human beings: comparison with thermodilution. J Am Soc Echocardiogr 20(2):103–112

    Article  PubMed  Google Scholar 

  12. Pemberton J, Li X, Karamlou T et al (2005) The use of live three-dimensional Doppler echocardiography in the measurement of cardiac output: an in vivo animal study. J Am Coll Cardiol 45(3):433–438

    Article  PubMed  Google Scholar 

  13. Schmidt FP, Gniewosz T, Jabs A et al (2014) Usefulness of 3D-PISA as compared to guideline endorsed parameters for mitral regurgitation quantification. Int J Cardiovasc Imaging 30(8):1501–1508

    Article  PubMed  Google Scholar 

  14. Choi J, Heo R, Hong GR et al (2014) Differential effect of 3-dimensional color Doppler echocardiography for the quantification of mitral regurgitation according to the severity and characteristics. Circ Cardiovasc Imaging 7(3):535–544

    Article  PubMed  Google Scholar 

  15. Thavendiranathan P, Liu S, Datta S et al (2012) Automated quantification of mitral inflow and aortic outflow stroke volumes by three-dimensional real-time volume color-flow Doppler transthoracic echocardiography: comparison with pulsed-wave Doppler and cardiac magnetic resonance imaging. J Am Soc Echocardiogr 25(1):56–65

    Article  PubMed  Google Scholar 

  16. Lancellotti P, Tribouilloy C, Hagendorff A et al (2013) Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 14(7):611–644

    Article  PubMed  Google Scholar 

  17. Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463

    Article  PubMed  Google Scholar 

  18. Zheng Y, Barbu A, Georgescu B, Scheuering M, Comaniciu D (2008) Four-chamber heart modeling and automatic segmentation for 3-D cardiac CT volumes using marginal space learning and steerable features. IEEE Trans Med Imaging 27(11):1668–1681

    Article  PubMed  Google Scholar 

  19. Matthews F, Largiader T, Rhomberg P, van der Loo B, Schmid ER, Jenni R (2010) A novel operator-independent algorithm for cardiac output measurements based on three-dimensional transoesophageal colour Doppler echocardiography. Eur J Echocardiogr 11(5):432–437

    Article  PubMed  Google Scholar 

  20. Hundley WG, Li HF, Willard JE et al (1995) Magnetic resonance imaging assessment of the severity of mitral regurgitation. Compa Invasive Tech Circ 92(5):1151–1158

    CAS  Google Scholar 

  21. Labovitz AJ, Ferrara RP, Kern MJ, Bryg RJ, Mrosek DG, Williams GA (1986) Quantitative evaluation of aortic insufficiency by continuous wave Doppler echocardiography. J Am Coll Cardiol 8(6):1341–1347

    Article  CAS  PubMed  Google Scholar 

  22. Teague SM, Heinsimer JA, Anderson JL et al (1986) Quantification of aortic regurgitation utilizing continuous wave Doppler ultrasound. J Am Coll Cardiol 8(3):592–599

    Article  CAS  PubMed  Google Scholar 

  23. Schwammenthal E, Chen C, Giesler M et al (1996) New method for accurate calculation of regurgitant flow rate based on analysis of Doppler color flow maps of the proximal flow field. Validation in a canine model of mitral regurgitation with initial application in patients. J Am Coll Cardiol 27(1):161–172

    Article  CAS  PubMed  Google Scholar 

  24. Tribouilloy CM, Enriquez-Sarano M, Fett SL, Bailey KR, Seward JB, Tajik AJ (1998) Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation. J Am Coll Cardiol 32(4):1032–1039

    Article  CAS  PubMed  Google Scholar 

  25. Sato Y, Kawazoe K, Nasu M, Hiramori K (1999) Clinical usefulness of the proximal isovelocity surface area method using echocardiography in patients with eccentric aortic regurgitation. J Heart Valve Dis 8(1):104–111

    CAS  PubMed  Google Scholar 

  26. Ewe SH, Delgado V, van der Geest R et al (2013) Accuracy of three-dimensional versus two-dimensional echocardiography for quantification of aortic regurgitation and validation by three-dimensional three-directional velocity-encoded magnetic resonance imaging. Am J Cardiol 112(4):560–566

    Article  PubMed  Google Scholar 

  27. Kizilbash AM, Hundley WG, Willett DL, Franco F, Peshock RM, Grayburn PA (1998) Comparison of quantitative Doppler with magnetic resonance imaging for assessment of the severity of mitral regurgitation. Am J Cardiol 81(6):792–795

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, College of Medicine, Hangang Sacred Heart Hospital, Hallym University, Chuncheon, South Korea

    Jaehuk Choi

  2. Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, South Korea

    Geu-Ru Hong, In Jeong Cho, Chi Young Shim, Hyuk-Jae Chang, Jong-Won Ha & Namsik Chung

  3. School of Medicine, University of Queensland, Herston, QLD, Australia

    Minji Kim

  4. Ultrasound Division, Siemens Medical Solutions USA Inc., Mountain View, CA, USA

    Joel Mancina

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  1. Jaehuk Choi
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Correspondence to Geu-Ru Hong.

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Geu-Ru Hong—Research Support from Siemens Medical Solution

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Choi, J., Hong, GR., Kim, M. et al. Automatic quantification of aortic regurgitation using 3D full volume color doppler echocardiography: a validation study with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 31, 1379–1389 (2015). https://doi.org/10.1007/s10554-015-0707-x

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  • DOI: https://doi.org/10.1007/s10554-015-0707-x

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