Usefulness of Vena Contracta for Identifying Severe Secondary Mitral Regurgitation: A Three-Dimensional Transesophageal Echocardiography Study.

BACKGROUND

In secondary mitral regurgitation (SMR), effective regurgitant orifice area by the proximal isovelocity surface area method ( ) evaluation might cause an underestimation of regurgitant orifice area because of its ellipticity compared with vena contracta area (VCA). We aimed to reassess the SMR severity using VCA-related parameters and .

METHODS

The three-dimensional transesophageal echocardiography data of 128 patients with SMR were retrospectively analyzed; the following parameters were evaluated: , anteroposterior and mediolateral vena contracta widths (VCWs) of VCA (i.e., and ), calculated as ( + )/2, and calculated as ( /2) ( /2). Severe SMR was defined as 0.39 .

RESULTS

The mean age of the patients was 77.0 8.9 years, and 78 (60.9%) were males. Compared with (r = 0.801), (r = 0.940) and (r = 0.980) were strongly correlated with VCA. On receiver-operating characteristic curve analysis, and had C-statistics of 0.981 (95% confidence interval [CI], 0.963-1.000) and 0.985 (95% CI, 0.970-1.000), respectively; these were significantly higher than 0.910 (95% CI, 0.859-0.961) in ( = 0.007 and = 0.003, respectively). The best cutoff values for severe SMR of and were 0.78 cm and 0.42 , respectively. The prevalence of severe SMR significantly increased with an increase in (38 of 88 [43.2%] patients with 0.30 , 21 of 24 [87.5%] patients with = 0.30-0.40 , and 16 of 16 [100%] patients with 0.40 [Cochran-Armitage test; 0.001]). Among patients with 0.30 , SMR severity based on VCA was accurately reclassified using (McNemar's test; = 0.505) and ( = 0.182).

CONCLUSIONS

Among patients who had SMR with of 0.30 , suggestive of moderate or less SMR according to current guidelines, 40% had discordantly severe SMR based on VCA. and values were useful for identifying severe SMR based on VCA in these patients.