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Grading of mitral regurgitation based on intensity analysis of the continuous wave Doppler signal

Milad El Haddad UGent, Tine De Backer UGent, MARC DE BUYZERE, Daniel Devos UGent, Abigaïl Swillens, Patrick Segers UGent and Frank Timmermans UGent (2017) HEART. 103(3). p.190-197
abstract
Objectives: Echocardiographic methods are used to quantify mitral regurgitation (MR) severity; however, their applicability, accuracy and reproducibility have been debated. We aimed to develop and validate a novel custom-made transthoracic echocardiographic method for grading MR severity based on average pixel intensity (API) analysis of the continuous wave (CW) Doppler envelope. Methods: MR was assessed in 290 patients using API, colour Doppler imaging, vena contracta width (VCW) and proximal iso-velocity surface area (PISA) method. For the validation of the API method, a pulsatile in vitro cardiac phantom was used. Results: Indices of MR severity, such as left ventricular and atrial dimension, pulmonary arterial pressure, significantly cosegregate with API severity (p <= 0.002). The API method showed a linear correlation with colour Doppler (r=0.79), VCW (r=0.68), PISA-effective regurgitant orifice area (r=0.72) and PISA-regurgitant volume (r=0.67); p<0.001 for all. The API was significantly more applicable than VCW (95% vs 75% of all patients; p<0.001) and PISA-based methods (65%; p<0.001). Additionally, the API showed a stronger intraobserver and interobserver agreement compared with other methods. Finally, in the in vitro validation, API values showed a strong linear correlation with increasing regurgitant volumes (r=0.81; p<0.001). Conclusions: We showed the clinical feasibility and in vitro validation of a novel digital quantitative echocardiographic method to grade MR severity. This method is more applicable and has less interobserver and intraobserver variability compared with current quantitative methods.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
ISOVELOCITY SURFACE-AREA, QUANTITATIVE ASSESSMENT, ORIFICE AREA, FLOW-RATE, IN-VITRO, SEVERITY, QUANTIFICATION, HEART, ECHOCARDIOGRAPHY, RECOMMENDATIONS
journal title
HEART
Heart
volume
103
issue
3
pages
190 - 197
Web of Science type
Article
Web of Science id
000394510200007
ISSN
1355-6037
DOI
10.1136/heartjnl-2016-309510
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
8050052
handle
http://hdl.handle.net/1854/LU-8050052
date created
2016-08-17 12:48:44
date last changed
2017-07-06 08:36:29
@article{8050052,
  abstract     = {Objectives: Echocardiographic methods are used to quantify mitral regurgitation (MR) severity; however, their applicability, accuracy and reproducibility have been debated. We aimed to develop and validate a novel custom-made transthoracic echocardiographic method for grading MR severity based on average pixel intensity (API) analysis of the continuous wave (CW) Doppler envelope. 
Methods: MR was assessed in 290 patients using API, colour Doppler imaging, vena contracta width (VCW) and proximal iso-velocity surface area (PISA) method. For the validation of the API method, a pulsatile in vitro cardiac phantom was used. 
Results: Indices of MR severity, such as left ventricular and atrial dimension, pulmonary arterial pressure, significantly cosegregate with API severity (p {\textlangle}= 0.002). The API method showed a linear correlation with colour Doppler (r=0.79), VCW (r=0.68), PISA-effective regurgitant orifice area (r=0.72) and PISA-regurgitant volume (r=0.67); p{\textlangle}0.001 for all. The API was significantly more applicable than VCW (95\% vs 75\% of all patients; p{\textlangle}0.001) and PISA-based methods (65\%; p{\textlangle}0.001). Additionally, the API showed a stronger intraobserver and interobserver agreement compared with other methods. Finally, in the in vitro validation, API values showed a strong linear correlation with increasing regurgitant volumes (r=0.81; p{\textlangle}0.001). 
Conclusions: We showed the clinical feasibility and in vitro validation of a novel digital quantitative echocardiographic method to grade MR severity. This method is more applicable and has less interobserver and intraobserver variability compared with current quantitative methods.},
  author       = {El Haddad, Milad and De Backer, Tine and DE BUYZERE, MARC and Devos, Daniel and Swillens, Abiga{\"i}l and Segers, Patrick and Timmermans, Frank},
  issn         = {1355-6037},
  journal      = {HEART},
  keyword      = {ISOVELOCITY SURFACE-AREA,QUANTITATIVE ASSESSMENT,ORIFICE AREA,FLOW-RATE,IN-VITRO,SEVERITY,QUANTIFICATION,HEART,ECHOCARDIOGRAPHY,RECOMMENDATIONS},
  language     = {eng},
  number       = {3},
  pages        = {190--197},
  title        = {Grading of mitral regurgitation based on intensity analysis of the continuous wave Doppler signal},
  url          = {http://dx.doi.org/10.1136/heartjnl-2016-309510},
  volume       = {103},
  year         = {2017},
}

Chicago
El Haddad, Milad, Tine De Backer, MARC DE BUYZERE, Daniel Devos, Abigaïl Swillens, Patrick Segers, and Frank Timmermans. 2017. “Grading of Mitral Regurgitation Based on Intensity Analysis of the Continuous Wave Doppler Signal.” Heart 103 (3): 190–197.
APA
El Haddad, M., De Backer, T., DE BUYZERE, M., Devos, D., Swillens, A., Segers, P., & Timmermans, F. (2017). Grading of mitral regurgitation based on intensity analysis of the continuous wave Doppler signal. HEART, 103(3), 190–197.
Vancouver
1.
El Haddad M, De Backer T, DE BUYZERE M, Devos D, Swillens A, Segers P, et al. Grading of mitral regurgitation based on intensity analysis of the continuous wave Doppler signal. HEART. 2017;103(3):190–7.
MLA
El Haddad, Milad, Tine De Backer, MARC DE BUYZERE, et al. “Grading of Mitral Regurgitation Based on Intensity Analysis of the Continuous Wave Doppler Signal.” HEART 103.3 (2017): 190–197. Print.