Echocardiographic Hemodynamic Burden Parameters Predict Mitral
Regurgitation Severity
Abstract
Background Mitral regurgitation (MR) is the most common
valvular heart disease. Since delaying severe MR treatment can lead to
left ventricular dysfunction, early MR diagnosis is crucial.
Echocardiography is the first-line diagnostic modality for evaluating MR
severity. Transesophageal echocardiography (TEE) and newer imaging
modalities like cardiac magnetic resonance imaging (CMR) are growing to
be used due to the pitfalls of transthoracic echocardiography (TTE).
However, these newer modalities have disadvantages, such as high cost,
requiring highly-skilled operators, and expensive devices, that make
them not widely available in developing countries. We evaluated novel
TTE-derived hemodynamic burden parameters of MR to estimate and classify
MR severity more precisely. Methods We prospectively enrolled
93 patients with primary MR from April 2022 to August 2022. We obtained
the baseline characteristics and the following TTE parameters: mitral
valve (MV) velocity-time integral (VTI), left ventricular outlet (LVOT)
diameter (D), LVOT VTI, and mitral valve annulus (MVA) diameter. The
statistical analysis was performed using SPSS. Results A total
of 93 MR patients with a median (interquartile range) age of 59.00
(50.50-65.00) were recruited, of whom 38 (40.9%) were female. Of the 93
patients, 29 (31.2%), 29 (31.2%), and 35 (37.6%) were classified into
mild, moderate, and severe MR, respectively. The four parameters of
MVVTI/LVOTVTI, MVAVTI-index (i), MVAVTI/LVOTDVTI, and E velocity-LA
area-i were shown to be significantly different among mild, moderate,
and severe MR groups (p-values <0.001). Spearman’s correlation
test indicated that MVVTI/LVOTVTI, MVAVTI-i, MVAVTI/LVOTDVTI, and E
velocity-LA area-i were highly and significantly correlated with MR
severity classification with correlation coefficients of 0.776, 0.672,
0.822, and 0.698, respectively (p-values <0.001). The
ROC-curve analysis demonstrated that all parameters were significantly
accurate predictors of severe MR diagnosis. The area under curve (AUC)
of the MVVTI/LVOTVTI, MVAVTI-i, MVAVTI/LVOTDVTI, and E velocity-LA
area-i were 0.976, 0.975, 0.986, and 0.895, respectively (p-values
<0.001) Conclusion We introduced novel TTE-derived MR
hemodynamic burden indices. These indices were highly correlated with MR
severity. Furthermore, they were significantly accurate predictors of
severe MR. Proposing such new indices to older measures may improve
their predictive value.