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Real-time three-dimensional color doppler evaluation of the flow convergence zone for quantification of mitral regurgitation: Validation experimental animal study and initial clinical experienceBACKGROUND: Pitfalls of the flow convergence (FC) method, including 2-dimensional imaging of the 3-dimensional (3D) geometry of the FC surface, can lead to erroneous quantification of mitral regurgitation (MR). This limitation may be mitigated by the use of real-time 3D color Doppler echocardiography (CE). Our objective was to validate a real-time 3D navigation method for MR quantification. METHODS: In 12 sheep with surgically induced chronic MR, 37 different hemodynamic conditions were studied with real-time 3DCE. Using real-time 3D navigation, the radius of the largest hemispherical FC zone was located and measured. MR volume was quantified according to the FC method after observing the shape of FC in 3D space. Aortic and mitral electromagnetic flow probes and meters were balanced against each other to determine reference MR volume. As an initial clinical application study, 22 patients with chronic MR were also studied with this real-time 3DCE-FC method. Left ventricular (LV) outflow tract automated cardiac flow measurement (Toshiba Corp, Tokyo, Japan) and real-time 3D LV stroke volume were used to quantify the reference MR volume (MR volume = 3DLV stroke volume - automated cardiac flow measurement). RESULTS: In the sheep model, a good correlation and agreement was seen between MR volume by real-time 3DCE and electromagnetic (y = 0.77x + 1.48, r = 0.87, P <.001, delta = -0.91 +/- 2.65 mL). In patients, real-time 3DCE-derived MR volume also showed a good correlation and agreement with the reference method (y = 0.89x - 0.38, r = 0.93, P <.001, delta = -4.8 +/- 7.6 mL). CONCLUSIONS: real-time 3DCE can capture the entire FC image, permitting geometrical recognition of the FC zone geometry and reliable MR quantification.
Document ID
Document Type
Reprint (Version printed in journal)
External Source(s)
Sitges, Marta (The Cleveland Clinic Foundation Cleveland, Ohio 44195, United States)
Jones, Michael
Shiota, Takahiro
Qin, Jian Xin
Tsujino, Hiroyuki
Bauer, Fabrice
Kim, Yong Jin
Agler, Deborah A.
Cardon, Lisa A.
Zetts, Arthur D.
Panza, Julio A.
Thomas, James D.
Date Acquired
August 21, 2013
Publication Date
January 1, 2003
Publication Information
Publication: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography
Volume: 16
Issue: 1
ISSN: 0894-7317
Subject Category
Life Sciences (General)
Distribution Limits
Validation Studies
Evaluation Studies
Non-NASA Center
Clinical Trial
NASA Discipline Cardiopulmonary