Abstract 3734: Live Three-Dimensional Color-Flow Doppler Improves the Comprehensive Analysis of Mitral Regurgitant Jet
Background: We sought to evaluate the potential interest of live three-dimensional (3D) color-flow Doppler in the assessment of mitral regurgitant (MR) jets.
Methods: One hundred patients (5917 years, 49 males) presenting with at ±least mild MR were prospectively studied using 2D echo and live 3D echo (Sonos Agilent 7500, Philips). Live 3D color-flow Doppler data were analyzed in a blinded fashion 8.3±6.9 months after acquisition. The convergence zone and the vena contracta sizes and shapes, the jet origin and the number of jets, the left atrial jet direction and extent were analyzed.
Results: For each patient 5.2 ± 2.5 3D volumes were acquired, including 2.1±1.1 color-flow volumes. Mean time for analysis was 7.0±2.9 min including 2.4±1.1 min for 3D color-flow doppler analysis. The quality of color-flow doppler images was considered as good in 28% of patients, as fair in 51%, and poor in 21%. The color-flow Doppler was analyzable in 95% of patients. Using Kappa statistics, 3D color-flow doppler demonstrated a good agreement with 2D echo in the localization of the main jet origin (Kappa: 0.85; 0.75– 0.95). The number of jets was 1.4±0.7 (1 to 4) per patient. The main jet origin was lateral in 5 % of patients, central in 62%, medial in 5%, and was extended all along the closure line in 23% of patients. Live 3D color-flow Doppler was particularly useful for the identification of multiple jets, diffuse regurgitation (all along the closure line), or commissural jet origin. Live 3D color-flow Doppler greatly improves the MR analysis, demonstrating a non hemispheric shape of convergence zone and a non circular vena contracta in up to 44% of patients. The subsequent discrepancy in MR quantification (between the PISA and the quantitative Doppler methods using 2D echo) had a clinical impact in about 10% of patients (ERO 0.1 vs 0.26 cm2). Moreover, the left atrial direction and extent of mitral jets could be easily appreciated, with a left atrial eccentric direction in 65% of patients.
Conclusion: Live 3D color-flow Doppler can be considered as a simple and useful tool to assess mitral jets allowing a semi-quantitative approach of MR, providing important additional information compared with 2D echocardiography, particularly in diffuse regurgitation or commissural jets.