Quantification of primary mitral regurgitation by echocardiography: A practical appraisal

Frontiers in Cardiovascular Medicine

Cardiovascular Medicine

André Vincentelli¹  Franck Levy²  David Vancraeynest³  Agnès Pasquet³  Bernhard L. Gerber³  Sylvestre Maréchaux⁴  Alexandre Altes⁵  Emmanuelle Vermes⁶  Christophe Tribouilloy⁶ 

[1] Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France;Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco;Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium;GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, France;GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, France;Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium;UR UPJV 7517, Jules Verne University of Picardie, Amiens, France;

关键词: primary mitral regurgitation;    echocardiography;    valvular regurgitation;    regurgitant volume;    regurgitant fraction;    heart valve disease (HVD);   

DOI  :  10.3389/fcvm.2023.1107724

 received in 2022-11-25, accepted in 2023-02-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.

【 授权许可】

Unknown   
© 2023 Altes, Vermes, Levy, Vancraeynest, Pasquet, Vincentelli, Gerber, Tribouilloy and Marechaux.