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Value of the proximal flow convergence method for quantification of the regurgitant volume in mitral regurgitation

Influence of the mechanism of regurgitation, the imaging of the flow convergence region, and different calculation modalities

Stellenwert der proximalen Flusskonvergenzmethode zur Bestimmung des Regurgitationsvolumens bei der Mitralklappeninsuffizienz—Einfluss des Insuffizienzmechanismus, der Flusskonvergenzdarstellung und verschiedener Korrekturalgorithmen

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Zusammenfassung

In der vorliegenden Untersuchung sollte der Stellenwert der proximalen Flusskonvergenzmethode zur Bestimmung des Regurgitationsvolumens der Mitralklappeninsuffizienz in Abhängigkeit von der Ursache der Insuffizienz, der Flusskonvergenzdarstellung und der Anwendung verschiedener Korrekturalgorithmen untersucht werden.

Methoden

Das Regurgitationsvolumen wurde bei 45 Patienten (Alter 61±13 Jahre) mit organischer (n=19) oder funktioneller (n=26) Mitralklappeninsuffizienz durch Messung der proximalen Flusskonvergenzradien bei Aliasinggeschwindigkeiten zwischen 14 und 64 cm/s im 2D-Farbdoppler bestimmt. Dabei wurden verschiedene Berechnungsalgorithmen wie eine geometrische Korrektur bei wandadhärenter Flusskonvergenzzone und ein vereinfachter Algorithmus, der als einzigen Messparameter den Flusskonvergenzradius benötigt, angewandt. Der Flusskonvergenzradius im M-Mode-Farbdoppler wurde bei einer Aliasinggeschwindigkeit von 28 cm/s dargestellt. Als Referenzmethode diente die quantitative Dopplerechokardiographie.

Ergebnisse

Bei organischer Mitralklappeninsuffizienz ergaben sich Korrelationskoeffizienten/ mittlere Differenzen zwischen der Flusskonvergenzmethode und der Referenzmethode von 0,25–0,43/46–111 ml vor und 0,58–0,67/15–17 ml nach geometrischer Korrektur für die untersuchten Aliasinggeschwindigkeiten. Im M-Mode-Farbdoppler fanden sich Werte von 0,68/85 ml. Die entsprechenden Werte bei funktioneller Insuffizienz lagen bei 0,74–0,88/–5–8 ml vor und 0,74–0,88/–7–5 ml nach geometrischer Korrektur im 2D-Farbdoppler und bei 0,88/–1 ml im M-Mode-Farbdoppler. Der vereinfachte Algorithmus ergab Regurgitationsvolumina, die den unkorrigierten Werten entsprachen.

Schlussfolgerung

Das Regurgitationsvolumen wurde bei Patienten mit organischer Mitralklappeninsuffizienz durch die Methode der proximalen Flusskonvergenz unabhängig von einer Korrektur und der Darstellung überschätzt, was den Stellenwert der Methode bei diesen Patienten erheblich einschränkte. Eine ausreichend zuverlässige Bestimmung des Regurgitationsvolumens war dagegen bei funktioneller Mitralklappeninsuffizienz möglich. Dabei konnte ein einfacher Berechnungsalgorithmus für das Regurgitationsvolumen verwendet werden.

Summary

The purpose of this study was to evaluate whether the underlying mechanism of mitral regurgitation influences the reliability of the proximal flow con- vergence method to assess the regurgitant volume. Furthermore, the mode of imaging the flow convergence region and different correction algorithms for calculation of the regurgitant volume were compared.

Methods

Regurgitant volume was assessed in 45 patients (age 61±13 years) with organic (n=19) and functional (n=26) mitral regurgitation by the proximal flow convergence method for aliasing velocities between 14 and 64 cm/s using two-dimensional color Doppler imaging. Different correction and calculation algorithms were compared. In addition, regurgitant volume was determined using color Doppler M-mode for an aliasing velocity of 28 cm/s. The quantitative Doppler method was used as reference.

Results

In organic mitral regurgitation correlation coefficients (mean differences) between the proximal flow convergence method and the reference method were 0.25–0.43/ 0.58–0.67 (46–111 ml/15–17 ml) before/after geometric correction of the regurgitant volume for the aliasing velocities investigated. The correlation coefficient (mean difference) using color Doppler M-mode imaging was 0.68 (85 ml). The corresponding values in functional mitral regurgitation were 0.74–0.88/0.74–0.88 (–5–8 ml/–7–5 ml) for two-dimensional color Doppler and 0.88 (–1 ml) for M-mode imaging.

Conclusions

The regurgitant volume was overestimated by the proximal flow convergence method in organic mitral regurgitation irrespective of the application of different correction algorithms or the use of color Doppler M-mode. A sufficiently reliable determination of the regurgitant volume by the proximal flow convergence method was possible in functional mitral regurgitation. In that case a simplified calculation of the regurgitant volume based on the proximal flow convergence method was feasible.

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Authors and Affiliations

  1. Abteilung für Kardiologie, Medizinische Klinik der Universität Ulm, Robert-Koch-Straße 8, 89081, Ulm, Germany

    G. Grossmann,  N. Marx,  J. Spiess &  M. Kochs

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  1. G. Grossmann
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  2. N. Marx
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  3. J. Spiess
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  4. M. Kochs
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Correspondence to G. Grossmann.

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Herrn Prof. Dr. Vinzenz Hombach zum 60. Geburtstag

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Grossmann, G., Marx, N., Spiess, J. et al. Value of the proximal flow convergence method for quantification of the regurgitant volume in mitral regurgitation. Z Kardiol 93, 944–953 (2004). https://doi.org/10.1007/s00392-004-0151-8

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  • DOI: https://doi.org/10.1007/s00392-004-0151-8

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