Available online 24 March 2024

3D VCA can overcome limitations of 2D echocardiography in MR grading.

Cut-off values for severity grading of 3D VCA have not been determined yet.

3D VCA showed optimal agreement with the multiparametric approach for MR grading.

3D VCA produces larger values compared to EROA-PISA method.

We present cut-off values of 3D VCA for MR quantification in patients with MVP.

Echocardiographic grading of mitral regurgitation (MR) in mitral valve prolapse (MVP) is challenging. 3D vena contracta area (3D VCA) has been proposed as valuable method. However, data defining the cut-off values of severity and validation in the subset of patients with MVP are scarce. The aim of this study was to validate the 3D VCA by 3D transesophageal color-Doppler echocardiography (3D-TEE) in patients with MVP and to define the cut-off values of severity grading. The secondary aim was to compare 3D VCA to the EROA-PISA method.

1138 patients with at least moderate MR who underwent TEE were included. 3D VCA was measured, the cut-off value and area under the curve (AUC) for the prediction of severe MR were estimated by ROC curve using guideline-suggested multiparametric approach as reference standard. In a subgroup of patients, 3D regurgitant volume (3D RV) and 3D fraction (3D RF) were calculated from mitral and left ventricular outflow tract stroke volumes to further validate 3D VCA against a 3D volumetric reference standard.

The optimal 3D VCA cut-off value for predicting severe MR was 0.45cm2 (specificity 0.87; sensitivity 0.90) with an AUC of 0.95 using multiparametric approach as reference. 3D VCA had a good linear correlation with EROA-PISA (r = 0.62, p<0.05) with larger values compared to EROA-PISA (0.63 cm2 vs 0.44cm2, p<0.05). A cut-off of 0.50cm2 (AUC of 0.84, sensitivity 0.78, specificity 0.78) predicts an EROA-PISA of 0.40cm2. 3D VCA had a good linear correlation with 3D RVOL (r= 0.56, p<0.01), with an AUC of 0.86 to predict a 3D RF > 50%.

The present study suggests 0.45 cm2 as the best cut-off value of 3D VCA to define severe MR in patients with MVP, showing an optimal agreement with the reference standard multiparametric approach and 3D RV.

2024 Published by Elsevier Inc. on behalf of the American Society of Echocardiography.