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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

      Quantitative assessment of aortic regurgitation (AR) remains challenging. The present study evaluated the accuracy of 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiography (TTE) for AR quantification, using 3D 3-directional velocity-encoded magnetic resonance imaging (VE-MRI) as the reference method. Thirty-two AR patients were included. With color Doppler TTE, 2D effective regurgitant orifice area (EROA) was calculated using the proximal isovelocity surface area method. From the 3D TTE multiplanar reformation data, 3D-EROA was calculated by planimetry of the vena contracta. Regurgitant volumes (RVol) were obtained by multiplying the 2D-EROA and 3D-EROA by the velocity-time integral of AR jet and compared with that obtained using VE-MRI. For the entire population, 3D TTE RVol demonstrated a strong correlation and good agreement with VE-MRI RVol (r = 0.94 and −13.6 to 15.6 ml/beat, respectively), whereas 2D TTE RVol showed a modest correlation and large limits of agreement with VE-MRI (r = 0.70 and −22.2 to 32.8 ml/beat, respectively). Eccentric jets were noted in 16 patients (50%). In these patients, 3D TTE demonstrated an excellent correlation (r = 0.95) with VE-MRI, a small bias (0.1 ml/beat) and narrow limits of agreement (−18.7 to 18.8 ml/beat). Finally, the kappa agreement between 3D TTE and VE-MRI for grading of AR severity was good (k = 0.96), whereas the kappa agreement between 2D TTE and VE-MRI was suboptimal (k = 0.53). In conclusion, AR RVol quantification using 3D TTE is accurate, and its advantage over 2D TTE is particularly evident in patients with eccentric jets.
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      References

        • Lancellotti P.
        • Tribouilloy C.
        • Hagendorff A.
        • Moura L.
        • Popescu B.A.
        • Agricola E.
        • Monin J.L.
        • Pierard L.A.
        • Badano L.
        • Zamorano J.L.
        • Sicari R.
        • Vahanian A.
        • Roelandt J.R.T.C.
        European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease).
        Eur J Echocardiogr. 2010; 11: 223-244
        • Zoghbi W.A.
        • Enriquez-Sarano M.
        • Foster E.
        • Grayburn P.A.
        • Kraft C.D.
        • Levine R.A.
        • Nihoyannopoulos P.
        • Otto C.M.
        • Quinones M.A.
        • Rakowski H.
        • Stewart W.J.
        • Waggoner A.
        • Weissman N.J.
        Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.
        J Am Soc Echocardiogr. 2003; 16: 777-802
        • Pirat B.
        • Little S.H.
        • Igo S.R.
        • McCulloch M.
        • Nosθ Y.
        • Hartley C.J.
        • Zoghbi W.A.
        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. 2009; 22: 306-313
        • Pouleur A.C.
        • de Waroux J.-BlP
        • Goffinet C.
        • Vancraeynest D.
        • Pasquet A.
        • Gerber B.L.
        • Vanoverschelde J.L.
        Accuracy of the flow convergence method for quantification of aortic regurgitation in patients with central versus eccentric jets.
        Am J Cardiol. 2008; 102: 475-480
        • Chin C.H.
        • Chen C.H.
        • Lo H.S.
        The correlation between three-dimensional vena contracta area and aortic regurgitation index in patients with aortic regurgitation.
        Echocardiography. 2010; 27: 161-166
        • Fang L.
        • Hsiung M.C.
        • Miller A.P.
        • Nanda N.C.
        • Yin W.H.
        • Young M.S.
        • Velayudhan D.E.
        Assessment of aortic regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation.
        Echocardiography. 2005; 22: 775-781
        • Marsan N.A.
        • Westenberg J.J.M.
        • Ypenburg C.
        • Delgado V.
        • van Bommel R.J.
        • Roes S.D.
        • Nucifora G.
        • van der Geest R.J.
        • de Roos A.
        • Reiber J.C.
        • Schalij M.J.
        • Bax J.J.
        Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance.
        JACC Cardiovasc Imaging. 2009; 2: 1245-1252
        • Yosefy C.
        • Hung J.
        • Chua S.
        • Vaturi M.
        • Ton-Nu T.T.
        • Handschumacher M.D.
        • Levine R.A.
        Direct measurement of vena contracta area by real-time 3-dimensional echocardiography for assessing severity of mitral regurgitation.
        Am J Cardiol. 2009; 104: 978-983
        • Roes S.D.
        • Hammer S.
        • van der Geest R.J.
        • Marsan N.A.
        • Bax J.J.
        • Lamb H.J.
        • Reiber J.H.
        • de Roos A.
        • Westenberg J.J.
        Flow assessment through four heart valves simultaneously using 3-dimensional 3-directional velocity-encoded magnetic resonance imaging with retrospective valve tracking in healthy volunteers and patients with valvular regurgitation.
        Invest Radiol. 2009; 44: 669-675
        • Westenberg J.J.M.
        • Roes S.D.
        • Ajmone Marsan N.
        • Binnendijk N.M.J.
        • Doornbos J.
        • Bax J.J.
        • Reiber J.H.C.
        • de Roos A.
        • van der Geest R.J.
        Mitral valve and tricuspid valve blood flow: accurate quantification with 3D velocity-encoded MR imaging with retrospective valve tracking.
        Radiology. 2008; 249: 792-800
        • Lang R.M.
        • Bierig M.
        • Devereux R.B.
        • Flachskampf F.A.
        • Foster E.
        • Pellikka P.A.
        • Picard M.H.
        • Roman M.J.
        • Seward J.
        • Shanewise J.S.
        • Solomon S.D.
        • Spencer K.T.
        • St John Sutton M.
        • Stewart W.J.
        Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group.
        J Am Soc Echocardiogr. 2005; 18: 1440-1463
        • van der Geest R.J.
        • Lelieveldt B.P.F.
        • Angelie E.
        • Danilouchkine M.
        • Swingen C.
        • Sonka M.
        • Reiber J.H.C.
        Evaluation of a new method for automated detection of left ventricular boundaries in time series of magnetic resonance images using an active appearance motion model.
        J Cardiovasc Magn Reson. 2004; 6: 609-617
        • Thomas G.B.
        • Finney R.
        Calculus and Analytic Geometry.
        9th ed. Addison Wesley, Boston1996
        • Bonow R.O.
        • Carabello B.A.
        • Chatterjee K.
        • de Leon Jr., A.C.
        • Faxon D.P.
        • Freed M.D.
        • Gaasch W.H.
        • Lytle B.W.
        • Nishimura R.A.
        • O'Gara P.T.
        • O'Rourke R.A.
        • Otto C.M.
        • Shah P.M.
        • Shanewise J.S.
        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.
        J Am Coll Cardiol. 2008; 52: e1-e142
        • Vahanian A.
        • Alfieri O.
        • Andreotti F.
        • Antunes M.J.
        • Barin-Esquivias G.
        • Baumgartner H.
        • Borger M.A.
        • Carrel T.P.
        • De Bonis M.
        • Evangelista A.
        • Falk V.
        • Iung B.
        • Lancellotti P.
        • Pierard L.
        • Price S.
        • Schafers H.J.
        • Schuler G.
        • Stepinska J.
        • Swedberg K.
        • Takkenberg J.
        • Von Oppell U.O.
        • Windecker S.
        • Zamorano J.L.
        • Zembala M.
        • SC Committee for Practice Guidelines (CPG)
        Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2012; 33: 2451-2496
        • Messika-Zeitoun D.
        • Detaint D.
        • Leye M.
        • Tribouilloy C.
        • Michelena H.I.
        • Pislaru S.
        • Brochet E.
        • Iung B.
        • Vahanian A.
        • Enriquez-Sarano M.
        Comparison of semiquantitative and quantitative assessment of severity of aortic eegurgitation: clinical implications.
        J Am Soc Echocardiogr. 2011; 24: 1246-1252
        • Detaint D.
        • Messika-Zeitoun D.
        • Maalouf J.
        • Tribouilloy C.
        • Mahoney D.W.
        • Tajik A.J.
        • Enriquez-Sarano M.
        Quantitative echocardiographic determinants of clinical outcome in asymptomatic patients with aortic regurgitation: a prospective study.
        JACC Cardiovasc Imaging. 2008; 1: 1-11
        • Hundley W.G.
        • Bluemke D.A.
        • Finn J.P.
        • Flamm S.D.
        • Fogel M.A.
        • Friedrich M.G.
        • Ho V.B.
        • Jerosch-Herold M.
        • Kramer C.M.
        • Manning W.J.
        • Patel M.
        • Pohost G.M.
        • Stillman A.E.
        • White R.D.
        • Woodard P.K.
        ACCF/ACR/AHA/NASCI/SCMR 2010 Expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on expert consensus documents.
        Circulation. 2010; 121: 2462-2508
        • Tribouilloy C.M.
        • Enriquez-Sarano M.
        • Fett S.L.
        • Bailey K.R.
        • Seward J.B.
        • Tajik A.J.
        Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation.
        J Am Coll Cardiol. 1998; 32: 1032-1039