Mitral valve navigator. A new diagnostic tool for effective regurgitant orifice quantification in mitral regurgitation

Abstract

Introduction: Mitral regurgitation severity assessment is usually carried out usingqualitative, semiquantitative, and quantitative parameters. The mitral valve naviga-tion (MVN) tool allows to measure the mitral effective regurgitant orifice (MERO)from 3D echo datasets. Our aim was to validate the MVN as a new tool to quantifyMERO. A secondary aim was to assess the intra- and interobserver variability.Methods: This is a retrospective study in which consecutive subjects undergoing atransoesophageal echocardiogram for more than mild mitral regurgitation evaluationwere included. MERO measurement obtained by means of 3D color Doppler wasused as the gold standard method for comparison. In every patient, MERO was alsoobtained using the MVN tool.Results: Fifty-nine consecutive patients were analyzed (47.5% female; mean age50.8 years). Mitral regurgitation was moderate in 23 (39%) and severe in 36 (61%)patients. Forty patients (67.8%) had a primary and 19 (32.2%) a secondary mitral re-gurgitation. The intraclass correlation coefficient (ICC) between 3D color Dopplerand MVN was excellent (ICC: 0.95; 95% CI: 0.82 to 0.98; P < 0.001) in the total groupand for patients with primary and secondary mitral regurgitation. Intra- and interob-server agreements were also good.Conclusions: Mitral valve navigator shows an excellent accuracy for measuringMERO when the transoesophageal 3D color Doppler is used as the reference method,either primary or secondary mitral regurgitation. Intraobserver reproducibility andinterobserver reproducibility are also excellent. These findings make this software agood alternative method to measure mitral regurgitation severity.