Three‐Dimensional Transesophageal Echocardiographic Vena Contracta Area for Grading Mitral Regurgitation: Severity Cut‐offs From a Prospective Tunisian Cohort
Aug 2026· Echocardiography· Vol 43· 0 citations· 26 references
Medicine
TL;DR
3D VCA reliably quantifies MR, provides aetiology‐specific cut‐offs and outperforms 2D methods in complex jets, andMulticenter validation is needed, particularly in rheumatic‐endemic regions.
Abstract
ABSTRACT Background Mitral regurgitation (MR) is among the most common valvular heart diseases, but its echocardiographic quantification remains challenging, particularly in secondary MR and in some organic causes. Three‐dimensional vena contracta area (3D VCA) allows direct planimetry of the regurgitant orifice. We aim to compare 3D VCA with two‐dimensional (2D) parameters and to derive aetiology‐specific severity cut‐offs in a Tunisian cohort. Methods Prospective cross‐sectional study. Patients with at least moderate MR underwent transthoracic and 2D/3D transesophageal echocardiography with planimetry of the VCA. Spearman correlations between 3D VCA and 2D parameters (vena contracta width, PISA‐derived regurgitant orifice area), and diagnostic performance for severe MR (ROC, Youden index), were analyzed. Results Ninety‐seven patients were included (mean age 61.6 ± 12.5 years; sex ratio 1.1). MR was primary in 66% (rheumatic 34%, degenerative 31%) and secondary in 34%; jets were mostly single, eccentric and holosystolic, and 62.9% had severe MR. 3D VCA correlated strongly with PISA‐derived orifice area (rho = 0.78) and with vena contracta width (rho = 0.65), particularly in organic, rheumatic, degenerative and eccentric MR. 3D VCA and 2D orifice area identified severe MR with an area under the curve of 0.93; the optimal 3D VCA cut‐off was 0.43 cm2 overall, 0.42 cm2 (rheumatic), 0.55 cm2 (degenerative) and 0.39 cm2 (secondary). Conclusion 3D VCA reliably quantifies MR, provides aetiology‐specific cut‐offs and outperforms 2D methods in complex jets. Multicenter validation is needed, particularly in rheumatic‐endemic regions.
Three-dimensional TEE-derived Vena Contracta area (3D TEE VCA) is a reliable and accurate method for assessing the severity of secondary mitral regurgitation and its use as a replacement for TEE warrants confirmation in larger multicenter studies with external validation.
R. Diab, E. R. Zaki, Badria A.E. Elhalawany· Echocardiography· 0 citations
Objectives: This study aimed to assess variations in mitral valve echocardiographic parameters in relation to gender and age using transthoracic 2-dimensional echocardiography in a subset of the Pakistani population.
Methodology: This cross-sectional study was conducted over six months (March–August 2024) at the National Institute of Cardiovascular Diseases (NICVD), Karachi, enrolling 385 individuals who fulfilled the inclusion criteria. Mitral valve echocardiographic parameters were measured using transthoracic 2D echocardiography and recorded on subject evaluation forms. Variations across gender and four age groups (18–30, 31–45, 46–65, and >65 years) were analyzed using the Kolmogorov-Smirnov test, Shapiro-Wilk test, Mann-Whitney U test, and Kruskal-Wallis test.
Results: Among 385 participants, 182 males and 203 females were examined. Posterior leaflet length was significantly greater in males than in females (p = 0.012), while all other parameters — annular diameter, annular area, anterior leaflet length and thickness, and posterior leaflet thickness — showed no statistically significant difference between genders. No parameter showed a statistically significant difference across age groups; posterior leaflet thickness did not reach statistical significance across age groups (p = 0.069).
Conclusion: In the Pakistani population, posterior leaflet length is significantly greater in males than in females. No statistically significant age-related differences were observed across any mitral valve parameter. These findings indicate a need for gender-specific reference values in echocardiographic assessment of the mitral valve in this population.
Mahail Khan, A. Qamar, S. Bhatti et al.· Pakistan Journal of Medical...· 0 citations
TTE is recommended as the first-line CRAT screening tool for MHD patients and combined TTE and DSA use improves diagnostic yield, and regular targeted surveillance for high-risk individuals reduces CRAT incidence.
Fen Yu, Xiaomei Huang, Jing-Jing Liu et al.· Journal of Clinical Medicine· 0 citations
BACKGROUND
Aortic stenosis (AS) and mitral regurgitation (MR) frequently co-occur, complicating diagnosis and treatment. We examined current US treatment trends and patient outcomes among patients with severe AS and at least moderate MR.
METHODS
We analyzed data from 2 992 362 patients (aged ≥18 years) undergoing 5 245 904 echocardiograms at 43 US institutions (Egnite Database; Egnite, Aliso Viejo, CA, with permissions) to identify a cohort of patients with severe AS and moderate or greater MR. The primary end point was 2-year all-cause mortality, assessed via Kaplan-Meier analysis. For patients undergoing transcatheter aortic valve replacement (TAVR) alone, MR severity changes from baseline to 45 days post-TAVR were visualized using Sankey diagrams.
RESULTS
The cohort included 36 402 patients (mean age, 78.2 years; 54.6% male), of whom 52.0% were untreated, 36.5% underwent TAVR alone, and 11.5% underwent surgery or other transcatheter interventions. Two-year mortality for untreated patients was 36.8% (95% CI, 35.6%-38.0%) for AS with less than moderate MR, 57.3% (95% CI, 54.0%-60.6%) for AS with moderate MR, and 65.5% (95% CI, 60.9%-70.1%) for AS with moderate-to-severe or severe MR (log-rank P<0.001). Undertreatment was more frequent in patients with AS and significant MR (64.5% versus 49.9%, P<0.001). Among patients undergoing TAVR alone with follow-up MR data, 77.5% demonstrated improvement in MR.
CONCLUSIONS
Patients with concurrent MR and AS exhibit substantially higher mortality yet have high rates of undertreatment throughout the duration of follow-up. TAVR alone significantly improves MR in most patients.
Benjamin E. Peterson, Philippe Généreaux, Pinak B. Shah et al.· Circulation. Cardiovascular...· 0 citations
Three-dimensional echocardiography compared well with CMR in delineation of severity of regurgitation (mild, moderate, and severe) and intra- and intra-observer reliability was excellent for ventricular volumes, VVR, and RF.
J. Kuebler, M. Moleon-Shea, Minmin Lu et al.· Pediatric Cardiology· 0 citations
In patients with DMR, AF was associated with more advanced LA structural remodeling, impaired LA function, and higher CMR LGE burden, and echocardiographic LA functional parameters may provide complementary information for the discrimination of AF.
X. Li, Y. Song, Y. Hu et al.· medRxiv· 0 citations
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