RT Journal Article
T1 Proximal flow convergence method by three-dimensional color doppler echocardiography for mitral valve area assessment in rheumatic mitral stenosis
A1 De Agustín Loeches, José Alberto
A1 Hernan Mejia, 
A1 Dafne Viliani, 
A1 Pedro Marcos-Alberca, 
A1 Jose Juan Gomez de Diego, 
A1 Ivan Javier Nunez-Gil, 
A1 Carlos Almeria, 
A1 Rodrigo López, José Luis
A1 Luaces Méndez, María
A1 García Fernández, Miguel Ángel
A1 Macaya Miguel, Carlos
A1 Pérez De Isla, Leopoldo
AB Background: The two-dimensional (2D) proximal isovelocity surface area (PISA) method has important technical limitations for mitral valve orifice area (MVA) assessment in mitral stenosis (MS), mainly the geometricassumptions of PISA shape and the requirement of an angle correction factor. Single-beat real-timethree-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometricassumptions or the requirement of an angle correction factor. The aim of this study was to validate this methodin patients with rheumatic MS.Methods: Sixty-three consecutive patients with rheumatic MS were included. MVA was assessed using thetransthoracic 2D and 3D PISA methods. Planimetry of MVA (2D and 3D) and the pressure half-time methodwere used as reference methods.Results: The 3D PISA method had better correlations with the reference methods (with 2D planimetry, r = 0.85,P < .001; with 3D planimetry, r = 0.89, P < .001; and with pressure half-time, r = 0.85, P < .001) than the conventional 2D PISA method (with 2D planimetry, r = 0.63, P < .001; with 3D planimetry, r = 0.66, P < .001; and withpressure half-time, r = 0.68, P < .001). In addition, a consistent significant underestimation of MVA using the conventional 2D PISA method was observed. A high percentage (30%) of patients with nonsevere MS by 3D planimetry were misclassified by the 2D PISA method as having severe MS (effective regurgitant orifice area < 1 cm2). Incontrast, the 3D PISA method had 94% agreement with 3D planimetry. Good intra- and interobserver agreementfor 3D PISA measurements were observed, with intraclass correlation coefficients of 0.95 and 0.90, respectively.Conclusions: MVA assessment using PISA by single-beat real-time 3D color Doppler echocardiography isfeasible in the clinical setting and more accurate than the conventional 2D PISA method. (J Am Soc Echocardiogr 2014;27:838-45.)
PB Elsevier
SN 1097-6795
YR 2014
FD 2014-08-01
LK https://hdl.handle.net/20.500.14352/131405
UL https://hdl.handle.net/20.500.14352/131405
LA eng
NO De Agustin JA, Mejia H, Viliani D, Marcos-Alberca P, Gomez De Diego JJ, Nuñez-Gil IJ, et al. Proximal Flow Convergence Method by Three-Dimensional Color Doppler Echocardiography for Mitral Valve Area Assessment in Rheumatic Mitral Stenosis. Journal of the American Society of Echocardiography 2014;27:838–45. https://doi.org/10.1016/j.echo.2014.04.023.
DS Docta Complutense
RD 21 mar 2026