Assessment of Mitral Regurgitation Severity by Doppler Color Flow Mapping of the Vena Contracta in Dogs

Overview

Journal J Vet Intern Med

Specialties General Medicine
Veterinary Medicine

Date 2014 Jun 18

PMID 24934609

Citations 5

Authors

M Di Marcello

E Terzo

C Locatelli

V Palermo

E Sala

E DallAglio

C M Bussadori

I Spalla

P G Brambilla

Affiliations

Soon will be listed here.

Abstract

Background: Quantitative and semiquantitative methods have been proposed for the assessment of MR severity, and though all are associated with limitations. Measurement of vena contracta width (VCW) has been used in clinical practice.

Objective: To measure the VCW in dogs with different levels of MR severity.

Animals: Two hundred and seventy-nine dogs were classified according to 5 levels of MR severity.

Methods: This was a retrospective study. EROA and regurgitant volume calculated by the PISA method, were measured and indexed to BSA. Descriptive statistics were calculated for VCW and VCW index for all categories of MR severity. Spearman's rank correlation coefficients (ρs ) were calculated to compare the results of the different methods (VCW and VCW index vs RV PISA, RV PISA index, EROA, EROA index), and between VCW and VCW index versus MR severity.

Results: All Spearman's rank correlation coefficients were significant (P < .001). The median values of VCW resulted of 2.9 mm (IQR 3.4-2.5) and of 4.6 mm (IQR 5.4-4.1) in the groups previously classified as mild-to-moderate and moderate-to-severe, respectively. The median values of VCW index resulted of 4.4 mm/m(2) (IQR = 5.5-4.2) in mild-to-moderate MR and of 10.8 mm/m(2) (IQR = 12.8-9.4) in moderate-to-severe MR.

Conclusion And Clinical Importance: This is not a validation study against any previously validated invasive gold standard, the VCW method has proved easy to employ and it might be an additional tool in quantifying disease severity that supports, rather than replace, data coming from other techniques in daily clinical practice and research.

Citing Articles

Radiographic lung congestion scores in dogs with acute congestive heart failure caused by myxomatous mitral valve disease.

Koster L, Vogel J, Springer C, Hecht S J Vet Intern Med. 2023; 37(6):1983-1991.

PMID: 37694988 PMC: 10658542. DOI: 10.1111/jvim.16850.

The Mitral INsufficiency Echocardiographic score: A severity classification of myxomatous mitral valve disease in dogs.

Vezzosi T, Grosso G, Tognetti R, Meucci V, Patata V, Marchesotti F J Vet Intern Med. 2021; 35(3):1238-1244.

PMID: 33951235 PMC: 8163114. DOI: 10.1111/jvim.16131.

Echocardiographic indices and severity of mitral regurgitation in dogs with preclinical degenerative mitral valve disease.

Larouche-Lebel E, Loughran K, Oyama M J Vet Intern Med. 2019; 33(2):489-498.

PMID: 30793808 PMC: 6430891. DOI: 10.1111/jvim.15461.

Review of Diagnostic and Therapeutic Approach to Canine Myxomatous Mitral Valve Disease.

Menciotti G, Borgarelli M Vet Sci. 2017; 4(4).

PMID: 29056705 PMC: 5753627. DOI: 10.3390/vetsci4040047.

Real-Time 3-Dimensional Echocardiographic Assessment of Effective Regurgitant Orifice Area in Dogs With Myxomatous Mitral Valve Disease.

Tidholm A, Bodegard-Westling A, Hoglund K, Haggstrom J, Ljungvall I J Vet Intern Med. 2017; 31(2):303-310.

PMID: 28109120 PMC: 5354031. DOI: 10.1111/jvim.14642.

References

Altiok E, Hamada S, van Hall S, Hanenberg M, Dohmen G, Almalla M . Comparison of direct planimetry of mitral valve regurgitation orifice area by three-dimensional transesophageal echocardiography to effective regurgitant orifice area obtained by proximal flow convergence method and vena contracta area determined by.... Am J Cardiol. 2011; 107(3):452-8. DOI: 10.1016/j.amjcard.2010.09.043. View

Ajmone Marsan N, Westenberg J, Ypenburg C, Delgado V, van Bommel R, Roes S . Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009; 2(11):1245-52. DOI: 10.1016/j.jcmg.2009.07.006. View

Jacobs G, Mahjoob K . Multiple regression analysis, using body size and cardiac cycle length, in predicting echocardiographic variables in dogs. Am J Vet Res. 1988; 49(8):1290-4. View

Choi H, Lee K, Lee H, Lee Y, Chang D, Eom K . Quantification of mitral regurgitation using proximal isovelocity surface area method in dogs. J Vet Sci. 2004; 5(2):163-71. View

Kahlert P, Plicht B, Schenk I, Janosi R, Erbel R, Buck T . Direct assessment of size and shape of noncircular vena contracta area in functional versus organic mitral regurgitation using real-time three-dimensional echocardiography. J Am Soc Echocardiogr. 2008; 21(8):912-21. DOI: 10.1016/j.echo.2008.02.003. View

Prakash A, Lacro R, Sleeper L, Minich L, Colan S, McCrindle B . Challenges in echocardiographic assessment of mitral regurgitation in children after repair of atrioventricular septal defect. Pediatr Cardiol. 2011; 33(2):205-14. PMC: 3265615. DOI: 10.1007/s00246-011-0107-5. View

Omran A, Arifi A, Mohamed A . Echocardiographic atlas of the mitral regurgitation. J Saudi Heart Assoc. 2013; 23(3):163-70. PMC: 3801145. DOI: 10.1016/j.jsha.2011.04.003. View

Kizilbash A, Willett D, Brickner M, Heinle S, Grayburn P . Effects of afterload reduction on vena contracta width in mitral regurgitation. J Am Coll Cardiol. 1998; 32(2):427-31. DOI: 10.1016/s0735-1097(98)00236-8. View

Grayburn P . How to measure severity of mitral regurgitation. Postgrad Med J. 2008; 84(994):395-402. DOI: 10.1136/hrt.2005.086462. View

10.

Zoghbi W, Enriquez-Sarano M, Foster E, Grayburn P, Kraft C, Levine R . Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr. 2003; 16(7):777-802. DOI: 10.1016/S0894-7317(03)00335-3. View

11.

Thomas L, Foster E, Schiller N . Peak mitral inflow velocity predicts mitral regurgitation severity. J Am Coll Cardiol. 1998; 31(1):174-9. DOI: 10.1016/s0735-1097(97)00454-3. View

12.

Irvine T, Li X, Sahn D, Kenny A . Assessment of mitral regurgitation. Heart. 2002; 88 Suppl 4:iv11-9. PMC: 1876280. DOI: 10.1136/heart.88.suppl_4.iv11. View

13.

Kittleson M, Brown W . Regurgitant fraction measured by using the proximal isovelocity surface area method in dogs with chronic myxomatous mitral valve disease. J Vet Intern Med. 2003; 17(1):84-8. DOI: 10.1892/0891-6640(2003)017<0084:rfmbut>2.3.co;2. View

14.

Yang W, Shim C, Kang M, Chang H, Chung N, Cho S . Vena contracta width as a predictor of adverse outcomes in patients with severe isolated tricuspid regurgitation. J Am Soc Echocardiogr. 2011; 24(9):1013-9. DOI: 10.1016/j.echo.2011.06.015. View

15.

Biner S, Rafique A, Rafii F, Tolstrup K, Noorani O, Shiota T . Reproducibility of proximal isovelocity surface area, vena contracta, and regurgitant jet area for assessment of mitral regurgitation severity. JACC Cardiovasc Imaging. 2010; 3(3):235-43. DOI: 10.1016/j.jcmg.2009.09.029. View

16.

Hall S, Brickner M, Willett D, Irani W, Afridi I, Grayburn P . Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. Circulation. 1997; 95(3):636-42. DOI: 10.1161/01.cir.95.3.636. View

17.

Hyodo E, Iwata S, Tugcu A, Arai K, Shimada K, Muro T . Direct measurement of multiple vena contracta areas for assessing the severity of mitral regurgitation using 3D TEE. JACC Cardiovasc Imaging. 2012; 5(7):669-76. DOI: 10.1016/j.jcmg.2012.03.008. View

18.

Khanna D, Miller A, Nanda N, Ahmed S, Lloyd S . Transthoracic and transesophageal echocardiographic assessment of mitral regurgitation severity: usefulness of qualitative and semiquantitative techniques. Echocardiography. 2005; 22(9):748-69. DOI: 10.1111/j.1540-8175.2005.00170.x. View

19.

Thomas L, Foster E, Hoffman J, Schiller N . The Mitral Regurgitation Index: an echocardiographic guide to severity. J Am Coll Cardiol. 1999; 33(7):2016-22. DOI: 10.1016/s0735-1097(99)00111-4. View

20.

Chetboul V, Tissier R . Echocardiographic assessment of canine degenerative mitral valve disease. J Vet Cardiol. 2012; 14(1):127-48. DOI: 10.1016/j.jvc.2011.11.005. View