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Reproducibility of transthoracic 3D echocardiography in the assessment of mitral valve area in patients with rheumatic mitral stenosis: real time versus ECG-gated 3D echocardiography

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Abstract

Purpose: To assess reproducibility of Real time 3D echocardiography (RT3D) and ECG-gated 3D echocardiography (EG3D) when measuring the mitral valve area (MVA) in rheumatic mitral stenosis (MS). Methods: MVA was assessed by three operators in 68 MS patients using RT3D and EG3D. Reproducibility of each technique was determined by calculating the standard error of measurements (SEM). Results: SEM was similar between RT3D and EG3D. MVA variability was of 0.4 cm² or 30% of any RT3D or EG3D measured MVA. The minimal change in MVA above which two measurements should be considered to differ significantly for the same operator was of 0.4 cm² for RT3D and 0.5 cm² for EG3D. For two different operators making successive measurements, the minimum significant change was of 0.5 cm² for RT3D and 0.6 cm² for EG3D. The minimum significant difference when switching from RT3D to EG3D or vice versa is of 0.6 cm². Low temporal resolution of 6 Hz has the least variability when using RT3D (0.19 cm² vs. 0.26 cm², p = 0.009) but significantly underestimated MVA (1.3 ± 0.4 cm² vs. 1.4 ± 0.4 cm², p < 10− 3) when compared to EG3D. MVA variability was significantly higher in mild MS when compared to severe MS whether it is RT3D (0.23 cm² vs. 0.18 cm², p = 0.02) or EG3D (0.27 cm² vs. 0.16 cm², p < 0.001). Conclusion: RT3D and EG3D are equally reproducible in the assessment of MVA in patients with MS. Further measurements standardization is required to have a clinically acceptable estimations of the true 3D MVA and minimal detectable differences.

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Data Availability

data can be made available upon reasonable request to the corresponding author.

Abbreviations

EGT3D:

ECG-gated 3D echocardiography

ICC:

Intraclass correlation coefficient

IPS:

Image per second

MDD95% :

Minimal detectable difference with 95% confidence

MS:

Mitral stenosis

MVA:

Mitral valve area

PTMC:

Percutaneous transvenous mitral commissurotomy

RT3D:

Real time 3D echocardiography

SC:

Surgical commissurotomy

SEM:

Standard error of measurements

TRVmax:

Tricuspid regurgitation maximum velocity

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Authors and Affiliations

  1. Cardiology A Department, Research Laboratory LR12 SP 16 Fattouma, University of Monastir, Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia

    Nidhal Bouchahda, Marwa Jarraya, Yessine Kallala, Ghada Sassi, Mehdi Boussaada, Mouna Bader, Marwen Mahjoub, Fethi Betbout, Habib Gamra, Majed Hassine & Mejdi Ben Messaoud

  2. Department of preventive Medicine, Faculty of Medicine, University of Monastir, Rue. Avicenne, 5019, Monastir, Tunisia

    Imen Zemni

  3. Cardiology Department, TAHER SFAR University Hospital, 5100, Mahdia, Tunisia

    Hassen Haj

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  1. Nidhal Bouchahda
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Nidhal Bouchahda ], [Marwa Jarray] and [Yessine Kallela].The first draft of the manuscript was written by [Nidhal Bouchahda] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Nidhal Bouchahda.

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This work has been approved by the Fattouma Burguiba Hospital local ethical committee.

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Bouchahda, N., Jarraya, M., Kallala, Y. et al. Reproducibility of transthoracic 3D echocardiography in the assessment of mitral valve area in patients with rheumatic mitral stenosis: real time versus ECG-gated 3D echocardiography. Int J Cardiovasc Imaging 39, 2419–2426 (2023). https://doi.org/10.1007/s10554-023-02939-2

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