This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Thomas, L. Articles by Schiller, N. B. Search for Related Content PubMed PubMed Citation Articles by Thomas, L. Articles by Schiller, N. B.

CLINICAL STUDIES

The mitral regurgitation index: an echocardiographic guide to severity

^a Division of Cardiology, University of California, San Francisco, California, USA

Manuscript received August 28, 1998; accepted February 8, 1999.

Reprint requests and correspondence: Dr. Nelson B. Schiller, Moffitt Hospital, 505 Parnassus Avenue, University of San Francisco, San Francisco, California 94143-0214.
schiller{at}cardio.ucsf.edu

OBJECTIVES

The purpose of this study was to develop a semiquantitative index of mitral regurgitation severity suitable for use in daily clinical practice and research.

BACKGROUND

There is no simple method for quantification of mitral regurgitation (MR). The MR Index is a semiquantitative guide to MR severity. The MR Index is a composite of six echocardiographic variables: color Doppler regurgitant jet penetration and proximal isovelocity surface area, continuous wave Doppler characteristics of the regurgitant jet and tricuspid regurgitant jet-derived pulmonary artery pressure, pulse wave Doppler pulmonary venous flow pattern and two-dimensional echocardiographic estimation of left atrial size.

METHODS

Consecutive patients (n = 103) with varying grades of MR, seen in the Adult Echocardiography Laboratory at UCSF, were analyzed retrospectively. All patients were evaluated for the six variables, each variable being scored on a four point scale from 0 to 3. The reference standards for MR were qualitative echocardiographic evaluation by an expert and quantitation of regurgitant fraction using two-dimensional and Doppler echocardiography. A subgroup of patients with low ejection fraction (EF <50%) were also analyzed.

RESULTS

The MR Index increased in proportion to MR severity with a significant difference among the three grades in both normal and low EF groups (F = 130 and F = 42, respectively, p < 0.0001). The MR Index correlated with regurgitant fraction (r = 0.76, p < 0.0001). An MR Index 2.2 identified 26/29 patients with severe MR (sensitivity = 90%, specificity = 88%, PPV = 79%). No patient with severe MR had an MR Index <1.8 and no patient with mild MR had an MR Index >1.7.

CONCLUSIONS

The MR Index is a simple semiquantitative estimate of MR severity, which seems to be useful in evaluating MR in patients with a low EF.

Abbreviations and Acronyms   CW = continuous wave   EF = ejection fraction   LA = left atrium   LV = left ventricular   MR = mitral regurgitation   PISA = proximal isovelocity surface area   RF = regurgitant fraction

This article has been cited by other articles:

				Y.-K. Guo, Z.-G. Yang, G. Ning, L. Rao, L. Dong, Y. Pen, T.-M. Zhang, Y. Wu, X.-C. Zhang, and Q.-L. Wang Isolated Mitral Regurgitation: Quantitative Assessment with 64-Section Multidetector CT--Comparison with MR Imaging and Echocardiography Radiology, August 1, 2009; 252(2): 369 - 376. [Abstract] [Full Text] [PDF]

				S. Buchner, K. Debl, F. Poschenrieder, S. Feuerbach, G. A.J. Riegger, A. Luchner, and B. Djavidani Cardiovascular Magnetic Resonance for Direct Assessment of Anatomic Regurgitant Orifice in Mitral Regurgitation Circ Cardiovasc Imaging, September 1, 2008; 1(2): 148 - 155. [Abstract] [Full Text] [PDF]

				P A Grayburn How to measure severity of mitral regurgitation Postgrad. Med. J., August 1, 2008; 84(994): 395 - 402. [Full Text] [PDF]

				P. A Grayburn How to measure severity of mitral regurgitation Heart, March 1, 2008; 94(3): 376 - 383. [Full Text] [PDF]

				A. J. Kerr, O. C. Raffel, G. A. Whalley, I. Zeng, and R. A. Stewart Elevated B-type natriuretic peptide despite normal left ventricular function on rest and exercise stress echocardiography in mitral regurgitation Eur. Heart J., February 1, 2008; 29(3): 363 - 370. [Abstract] [Full Text] [PDF]

				E. Donal, J. A. Sallach, R. D. Murray, J. K. Drinko, S. E. Jasper, J. D. Thomas, and A. L. Klein Contrast-enhanced tissue Doppler imaging of the left atrial appendage is a new quantitative measure of spontaneous echocardiographic contrast in atrial fibrillation Eur J Echocardiogr, January 1, 2008; 9(1): 5 - 11. [Abstract] [Full Text] [PDF]

				W. A. Zoghbi, M. Enriquez-Sarano, E. Foster, P. A. Grayburn, C. D. Kraft, R. A. Levine, P. Nihoyannopoulos, C. M. Otto, M. A. Quinones, H. Rakowski, et al. American Society of Echocardiography: recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography : A report from the American Society of Echocardiography's Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation, developed in conjunction with the American College of Cardiology Echocardiography Committee, The Cardiac Imaging Committee, Council on Clinical Cardiology, The American Heart Association, and the European Society of Cardiology Working Group on Echocardiography, represented by: Eur J Echocardiogr, December 1, 2003; 4(4): 237 - 261. [Full Text] [PDF]

				A. Rovner, R. Smith, N. L. Greenberg, E. M. Tuzcu, N. Smedira, H. M. Lever, J. D. Thomas, and M. J. Garcia Improvement in diastolic intraventricular pressure gradients in patients with HOCM after ethanol septal reduction Am J Physiol Heart Circ Physiol, December 1, 2003; 285(6): H2492 - H2499. [Abstract] [Full Text] [PDF]

				S E Karagiannis, G T Karatasakis, N Koutsogiannis, G D Athanasopoulos, and D V Cokkinos Increased distance between mitral valve coaptation point and mitral annular plane: significance and correlations in patients with heart failure Heart, October 1, 2003; 89(10): 1174 - 1178. [Abstract] [Full Text] [PDF]

				T. M. Sutton, R. A. H. Stewart, I. L. Gerber, T. M. West, A. M. Richards, T. G. Yandle, and A. J. Kerr Plasma natriuretic peptide levels increase with symptoms and severity of mitral regurgitation J. Am. Coll. Cardiol., June 18, 2003; 41(12): 2280 - 2287. [Abstract] [Full Text] [PDF]

				T. Tabata, J. D. Thomas, and A. L. Klein Pulmonary venous flow by doppler echocardiography: revisited 12 years later J. Am. Coll. Cardiol., April 16, 2003; 41(8): 1243 - 1250. [Abstract] [Full Text] [PDF]

				J. A. Fox, V. Formanek, A. Friedrich, and S. K. Shernan Intraoperative Echocardiography Card. Surg. Adult, January 1, 2003; 2(2003): 283 - 314. [Full Text]

				L. A. Freed, E. J. Benjamin, D. Levy, M. G. Larson, J. C. Evans, D. L. Fuller, B. Lehman, and R. A. Levine Mitral valve prolapse in the general population: the benign nature of echocardiographic features in the Framingham Heart Study J. Am. Coll. Cardiol., October 2, 2002; 40(7): 1298 - 1304. [Abstract] [Full Text] [PDF]

				Y. Otsuji, T. Kumanohoso, S. Yoshifuku, K. Matsukida, C. Koriyama, A. Kisanuki, S. Minagoe, R. A. Levine, and C. Tei Isolated annular dilation does not usually cause important functional mitral regurgitation: Comparison between patients with lone atrial fibrillation and those with idiopathic or ischemic cardiomyopathy J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1651 - 1656. [Abstract] [Full Text] [PDF]

				T. L. Gentles, S. D. Colan, N. J. Wilson, R. Biosa, and J. M. Neutze Left ventricular mechanics during and after acute rheumatic fever: contractile dysfunction is closely related to valve regurgitation J. Am. Coll. Cardiol., January 1, 2001; 37(1): 201 - 207. [Abstract] [Full Text] [PDF]