CLINICAL RESEARCH: ECHOCARDIOGRAPHY
Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation
An accurate and novel approach
José Zamorano, MD*,*,
Pedro Cordeiro, MD*,
Lissa Sugeng, MD ,
Leopoldo Perez de Isla, MD*,
Lynn Weinert, MD,
Carlos Macaya, MD*,
Enrique Rodríguez, MD* and
Roberto M. Lang, MD
* Echocardiography Laboratory, Hospital Clínico San Carlos, Madrid, Spain
University Hospital of Chicago, Chicago, Illinois, USA
Manuscript received October 21, 2003;
revised manuscript received December 16, 2003,
accepted January 6, 2004.
* Reprint requests and correspondence: Dr. José Zamorano, Echocardiographic Laboratory, Hospital Clínico San Carlos, Plaza Cristo Rey, 28040-Madrid, Spain.
jlzamorano{at}vodafone.es
OBJECTIVES: Our aim was to assess which echo-Doppler method has the best agreement with the mitral valve area (MVA) invasively evaluated by the Gorlin's formula. We also evaluated the feasibility and reproducibility of real-time three-dimensional echocardiography (RT3D) for the estimation of MVA and the Wilkins score in patients with rheumatic mitral stenosis (RMVS).
BACKGROUND: Real-time three-dimensional echocardiography is a novel technique that allows us to visualize the mitral valvular anatomy in any desired plane orientation. The usefulness and accuracy of this technique for evaluating RMVS has not been established.
METHODS: We studied a series of consecutive patients with RMVS from two tertiary care hospitals. Mitral valvular area was determined by conventional echo-Doppler methods and by RT3D, and their results were compared with those obtained invasively. Real-time three-dimensional echocardiography planimetry and mitral score were measured by two independent observers and then repeated by one of them.
RESULTS: Eighty patients with RMVS comprised our study group (76 women; 50.6 ± 13.9 years). Compared with all other echo-Doppler methods, RT3D had the best agreement with the invasively determined MVA (average difference between both methods and limits of agreement: 0.08 cm2 [–0.48 to 0.6]). Interobserver variability was as good for RT3D (intraclass correlation coefficient [ICC] = 0.90) as for pressure half-time (PHT) (ICC = 0.95). For PHT and RT3D, the intraobserver variability was similar (ICC 0.92 and 0.96, respectively). Real-time three-dimensional echocardiography valvular score evaluation showed a better interobserver agreement with RT3D than with 2D echocardiography.
CONCLUSIONS: Real-time three-dimensional echocardiography is a feasible, accurate, and highly reproducible technique for assessing MVA in patients with RMVS. Real-time three-dimensional echocardiography has the best agreement with invasive methods.
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Abbreviations and Acronyms
| | ICC | = intraclass correlation coefficient | | MVA | = mitral valvular area | | PHT | = pressure half-time | | PISA | = proximal isovelocity surface area | | RMVS | = rheumatic mitral valve stenosis | | RT3D | = real-time three-dimensional echocardiography | | 2D | = two-dimensional echocardiography | | 3D | = three-dimensional echocardiography |
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