Comparison mitral valve area measurement by 2D and 3D echocardiography in in mitral stenosis

Abstract

The decision for invasive measures to treat mitral stenosis is mainly based on mitral valve area (MVA). However, the evaluation of MVA calculated by different methods is associated with difficulties and in some patients the area calculated by different methods is not consistent. Therefore, the aim of this study was to evaluate planimetric results with 2D and 3D methods, to compare the results of Doppler based methods including PHT and PISA with 3D results and to compare planimetric results in 3D with and without using MPR software in determining MVA. Materials and Methods: In this cross-sectional study, all patients with a diagnosis of mitral stenosis in the field of rheumatic disease referred to the echocardiography department of Shahid Madani Hospital during the years 1397-1396 were included in the study. Demographic and clinical information of patients were obtained. To evaluate MVA in 2D method, planimetry, PHT, PISA were used to determine the level of MVA. Also moderate and peak mitral gradient, maximum blood flow velocity passing through mitral, LA volume index, Ejection Fraction (EF), mitral regurgitation intensity based on semi-quantitative color Doppler evaluation, concomitant presence of tricuspid stenosis (TS) based on PHT, severity Aortic stenosis was calculated based on Continuity Equation, tricuspid regurgitation intensity and aortic regurgitation intensity based on semi-quantitative evaluation with color Doppler. In the 3D trans esophageal method, the surface of the mitral valve was calculated by two methods of evaluation with 3D Zoom and also by MPR method. In the 3D Zoom method, mitral area was calculated from both LA and LV regions. Results: Out of 149 patient , 109 (73.2%) were women and 40(26.8%) were men . Mean age was 51.75 (SD ± 9.81) years. There was significant correlation between 2D planimetry (mean = 1.05 cm2 , SD ±0.26 ) with 3D.direct (mean = 0.99 cm2 ,SD ± 0.29) (P value = 0.001 , pearson correlation = 0.787),between 3D.direct with 3D.MPR (mean = 1.12 cm2, SD ±0.45) (P value = 0.001 , pearson correlation = 0.655)and between 2D with 3D.MPR (P value = 0.001 , pearson correlation = 0.644). The net difference between the medians of 3D and MPR method was 0.13 cm2 (SD±0.27), difference between 3D LA view and LV view methods was 0.01 cm2 (SD± 0.08) , difference between 2D and 3D was 0.06 ( SD±0.37) ,and difference between 2D and MPR means 0.07 cm2 (SD±0.36) . Severe MR was seen in 10.1% and moderate MR in 24.7 % of patients. Most difference between all methods was at MVA larger than 1.0 cm2 in comparsion to less than 1.0 cm 2 .