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Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?

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Abstract

3D direct planimetry is increasingly used in clinical practice as a rapid way to measure the mitral valve area (MVA) in patients with rheumatic mitral stenosis (MS) who underwent three-dimensional transesophageal echocardiography (3D-TEE). However, data on its accuracy and reliability are scarce. This study aimed to compare the MVA measurements obtained by 3D direct planimetry to the conventional technique multiplanar reconstruction (MPR) in MS patients using 3D-TEE. We retrospectively included 49 patients with rheumatic MS undergoing clinically-indicated 3D-TEE in the study. We determined the 3D direct planimetry measurements of MVA from the left atria aspect (MVALA) and the left ventricle aspect (MVALV), and compared those with the MPR method (MVAMPR). We also assessed the major and minor diameters of the mitral valve orifice using MPR and 3D direct planimetry. We found an excellent agreement between the MVA measurements obtained by the MPR method and 3D direct planimetry (MVALA and MVALV) [intraclass correlation coefficients (ICC) = 0.951 and 0.950, respectively]. However, the MVAMPR measurements were significantly larger than the MVALA and MVALV (p < 0.001; mean difference: 0.12 ± 0.15 cm2 and 0.11 ± 0.16 cm2, respectively).The inter-observer and intra-observer variability ICC were 0.875 and 0.856 for MVAMPR, 0.982 and 0.984 for MVALA, and 0.988 and 0.986 for MVALV, respectively. The major diameter measured by MPR (1.90 ± 0.42 cm) was significantly larger than that obtained by 3D direct planimetry (1.72 ± 0.35 cm for the LA aspect, p < 0.001; 1.73 ± 0.36 cm for the LV aspect, p < 0.001). The minor diameter measured by MPR (0.96 ± 0.25 cm) did not differ from that derived by 3D direct planimetry (0.94 ± 0.25 cm for the LA aspect, p = 0.07; 0.95 ± 0.27 cm for the LV aspect, p = 0.32). 3D direct planimetry provides highly reproducible measurements of MVA and yields data in excellent agreement with those obtained by the MPR method. The discrepancy between the two techniques may be due to differences in major diameter measurements of the mitral valve orifice.

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Data availability

The data that support the findings of this study are available on request. The data are not publicly available due to the containing information that could compromise the privacy of research participants.

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Authors and Affiliations

  1. Echo Lab, Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China

    Xinbo Zhong & Ruiqiang Guo

  2. Department of Echocardiography, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, 518057, China

    Xinbo Zhong, Wenbin Chen, Zhiyong Shi, Zhifu Huan, Lanxiang Ma, Wei Liu & Yong Jiang

  3. Department of Cardiovascular Surgery, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, 518057, China

    Xiaohan Yang

  4. Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, 518057, China

    Xinbo Zhong & Yan Xu

  5. Laboratory of Cardiac Imaging and 3D Printing, Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, Hong Kong, China

    Alex Pui-Wai Lee

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  1. Xinbo Zhong
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Correspondence to Ruiqiang Guo.

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Zhong, X., Chen, W., Shi, Z. et al. Three-dimensional transesophageal echocardiography measurement of mitral valve area in patients with rheumatic mitral stenosis: multiplanar reconstruction or 3D direct planimetry?. Int J Cardiovasc Imaging 37, 99–107 (2021). https://doi.org/10.1007/s10554-020-01950-1

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