BACKGROUND The aim of this study was to evaluate the accuracy of mitral regurgitation (MR) volume quantified on three-dimensional (3D) color Doppler transesophageal echocardiography (TEE) using new semiautomated software compared with conventional two-dimensional (2D) proximal isovelocity surface area (PISA) transthoracic echocardiography (TTE) and TEE and cardiac magnetic resonance imaging (CMR). METHODS Fifty-one patients (mean age, 63 ± 16 years; 35 men) prospectively underwent TTE, TEE, and CMR for MR evaluation. Regurgitant volume (RVol) by 3D MR flow quantification was compared with 2D TTE, TEE, and CMR, and the accuracy of evaluation of severe MR by 3D MR flow quantification was compared against guideline criteria by TEE. RESULTS Twenty-nine patients had severe MR, 16 had moderate MR, and six had mild MR. Three-dimensional MR flow quantification was feasible in all patients, including prolapse (n = 37), restriction (n = 9), functional MR (n = 5), and eccentric or multiple jects (n = 41). RVol on 3D MR flow quantification correlated well with RVol on 2D PISA TTE (interclass correlation coefficient [ICC] = 0.75, P < .001), quantitatively estimated RVol (ICC = 0.74, P < .001), and 2D PISA TEE (ICC = 0.79, P < .001). Three-dimensional MR flow quantification agreed better with CMR (ICC = 0.86, P < .001) than did RVol on 2D PISA TTE (ICC = 0.66, P < .001) and 2D PISA TEE (ICC = 0.69, P < .001), with narrower limits of agreement on Bland-Altman analysis. Three-dimensional MR flow quantification had high accuracy for diagnosing severe MR using TEE (area under the curve = 0.85, 95% CI 0.74-0.96, P < .001) or CMR (area under the curve = 0.95; 95% CI, 0.89-1.00; P < .001) as the criterion. CONCLUSIONS The new software enabled semiautomated 3D MR flow quantification in complex MR with multiple and eccentric jets and showed better agreement with CMR than 2D PISA TTE or TEE, suggesting that this method is more accurate than conventional 2D PISA TTE and TEE.

中文翻译：

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三维彩色多普勒经食管超声心动图对二尖瓣返流半自动量化的验证。

背景 本研究的目的是评估使用新的半自动软件在三维 (3D) 彩色多普勒经食道超声心动图 (TEE) 上量化的二尖瓣反流 (MR) 容积的准确性，与传统的二维 (2D) 近端等速表面积相比。 (PISA) 经胸超声心动图 (TTE) 和 TEE 以及心脏磁共振成像 (CMR)。方法 51 名患者（平均年龄 63 ± 16 岁；35 名男性）前瞻性地接受了 TTE、TEE 和 CMR 以进行 MR 评估。将 3D MR 血流定量的返流量 (RVol) 与 2D TTE、TEE 和 CMR 进行比较，并将 3D MR 血流定量评估重度 MR 的准确性与 TEE 的指南标准进行比较。结果 29 名患者为重度 MR，16 名患者为中度 MR，6 名患者为轻度 MR。三维 MR 血流量化在所有患者中都是可行的，包括脱垂 (n = 37)、限制 (n = 9)、功能性 MR (n = 5) 和偏心或多个对象 (n = 41)。3D MR 血流定量的 RVol 与 2D PISA TTE 的 RVol（组间相关系数 [ICC] = 0.75，P < .001）、定量估计的 RVol（ICC = 0.74，P < .001）和 2D PISA TEE（ICC = 0.79，P < .001）。与 RVol 在 2D PISA TTE（ICC = 0.66，P < .001）和 2D PISA TEE（ICC = 0.69，P < .001）上相比，CMR 的三维 MR 血流定量更符合 CMR（ICC = 0.86，P < .001） )，在 Bland-Altman 分析上的一致性范围更窄。三维 MR 血流定量对于使用 TEE 诊断严重 MR 具有很高的准确性（曲线下面积 = 0.85，95% CI 0.74-0.96，P < . 001) 或 CMR（曲线下面积 = 0.95；95% CI，0.89-1.00；P < .001）作为标准。结论 新软件在具有多个偏心射流的复杂 MR 中实现了半自动 3D MR 流量量化，并且与 CMR 的一致性优于 2D PISA TTE 或 TEE，表明该方法比传统的 2D PISA TTE 和 TEE 更准确。