Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging.
[en] Valvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate the quantification of the regurgitation, assessment of the valve anatomy and function, as well as the consequences of valvular disease on cardiac chambers. In clinical practice, the management of patients with valvular regurgitation thus largely integrates the results of echocardiography. It is crucial to provide standards that aim at establishing a baseline list of measurements to be performed when assessing regurgitation.
Disciplines :
Cardiovascular & respiratory systems Radiology, nuclear medicine & imaging
Pierard, Luc ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Badano, Luigi
Zamorano, Jose L.
Language :
English
Title :
Recommendations for the echocardiographic assessment of native valvular regurgitation: an executive summary from the European Association of Cardiovascular Imaging.
ZoghbiWA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echo 2003;16:777-802. (Pubitemid 37391035)
Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E et al. European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). Eur J Echocardiogr 2010;11: 223-44.
Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy Cet al. European Association of Echocardiography. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010;11:307-32.
Lang RM, Badano LP, TsangW, Adams DH, Agricola E, Buck Tet al. EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2012;13:1-46.
Carpentier A, Chauvaud S, Fabiani JN, Deloche A, Relland J, Lessana A et al. Reconstructive surgery of mitral valve incompetence: ten-year appraisal. J Thorac Cardiovasc Surg 1980;79:338-48. (Pubitemid 10131047)
Vahanian A, Alfieri O, Andreotti F, Antunes M, Baron-Esquivias G, Baumgartner H et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2012;33:2451-96.
Pierard LA, Lancellotti P. Stress testing in valve disease. Heart 2007;93:766-72. (Pubitemid 46808290)
Muraru D, Badano LP, Vannan M, Iliceto S. Assessment of aortic valve complex by three-dimensional echocardiography: a framework for its effective application in clinical practice. Eur Heart J Cardiovasc Imaging 2012;13:541-55.
deWaroux JB, PouleurAC, Goffinet C, Vancraeynest D, Van Dyck M, RobertAet al. Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation 2007;116:1264-9.
Perry GJ, Helmcke F,NandaNC,Byard C, Soto B. Evaluation of aortic insufficiency by Doppler colour flow mapping. J Am Coll Cardiol 1987;9:952-9. (Pubitemid 17044944)
Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Seward JB, Tajik AJ. Assessment of severity of aortic regurgitation using the width of the vena contracta: a clinical color Doppler imaging study. Circulation 2000;102:558-64. (Pubitemid 30639974)
Eren M, Eksik A, Gorgulu S, Norgaz T, Dagdeviren B, BolcaOet al. Determination of vena contracta and its value in evaluating severity of aortic regurgitation. J Heart Valve Dis 2002;11:567-75. (Pubitemid 34812130)
Fang L, Hsiung MC, Miller AP, Nanda NC, Yin WH, Young MS et al. Assessment of aortic regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area: usefulness and validation. Echocardiography 2005; 22:775-81. (Pubitemid 44933465)
Tribouilloy CM, Enriquez-Sarano M, Fett SL, Bailey KR, Seward JB, Tajik AJ. Application of the proximal flow convergence method to calculate the effective regurgitant orifice area in aortic regurgitation. J Am Coll Cardiol 1998;32:1032-9. (Pubitemid 28459596)
Pouleur AC, deWaroux JB, Goffinet C, Vancraeynest D, Pasquet A, Gerber BL et al. Accuracy of the flow convergence method for quantification of aortic regurgitation in patients with central versus eccentric jets. Am J Cardiol 2008;102:475-80.
Tribouilloy C, Avinée P, Shen WF, Rey JL, Slama M, Lesbre JP. End diastolic flow velocity just beneath the aortic isthmus assessed by pulsed Doppler echocardiography: a new predictor of the aortic regurgitant fraction. Br Heart J 1991;65:37-40.
Samstad SO, Hegrenaes L, Skjaerpe T, Hatle L. Half time of the diastolic aortoventricular pressure difference by continuous wave Doppler ultrasound: a measure of the severity of AR?. Br Heart J 1989;61:336-43. (Pubitemid 19105198)
Griffin BP, Flachskampf FA, Siu S,Weyman AE, Thomas JD. The effects of regurgitant orifice size, chamber compliance, and systemic vascular resistance on aortic regurgitant velocity slope and pressure half-time. Am Heart J 1991;122:1049-56.
Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J 2005;26:433-9. (Pubitemid 40314758)
Maciel BC, Simpson IA, Valdes-Cruz LM, Recusani F, Hoit B, Dalton N et al. Color flowDopplermapping studies of 'physiologic' pulmonary and tricuspid regurgitation: evidence for true regurgitation as opposed to a valve closing volume. J Am Soc Echocardiogr 1991;4:589-97.
Kobayashi J, Nakano S, Matsuda H, Arisawa J, Kawashima Y. Quantitative evaluation of pulmonary regurgitation after repair of tetralogy of Fallot using real-time flow imaging system. Jpn Circ J 1989;53:721-7. (Pubitemid 19270994)
Williams RV, Minich LL, Shaddy RE, Pagotto LT, Tani LY. Comparison of Doppler echocardiography with angiography for determining the severity of pulmonary regurgitation. Am J Cardiol 2002;89:1438-41. (Pubitemid 34607792)
Puchalski MD, Askovich B, Sower CT, Williams RV, Minich LL, Tani LY. Pulmonary regurgitation: determining severity by echocardiography and magnetic resonance imaging. Congenit Heart Dis 2008;3:168-75. (Pubitemid 351843828)
Pothineni KR,Wells BJ, Hsiung MC, Nanda NC, Yelamanchili P, Suwanjutah T et al. Live/real time three-dimensional transthoracic echocardiographic assessment of pulmonary regurgitation. Echocardiography 2008;25:911-7.
Goldberg SJ, Allen HD. Quantitative assessment by Doppler echocardiography of pulmonary or aortic regurgitation. Am J Cardiol 1985;56:131-5. (Pubitemid 15069301)
Lei MH, Chen JJ, Ko YL, Cheng JJ, Kuan P, LienWP. Reappraisal of quantitative evaluation of pulmonary regurgitation and estimation of pulmonary artery pressure by continuous wave Doppler echocardiography. Cardiology 1995;86:249-56.
Silversides CK, Veldtman GR, Crossin J, Merchant N, Webb GD, McGrindle BW et al. Pressure Halftime predicts hemodynamically significant pulmonary regurgitation in adult patients with repaired tetralogy of Fallot. J Am Soc Echocardiogr 2003; 16:1057-62. (Pubitemid 37210933)
O'Gara P, Sugeng L, Lang R, Sarano M, Hung J, Raman S et al. The role of imaging in chronic degenerative mitral regurgitation. JACC Cardiovasc Imaging 2008;1:221-37. (Pubitemid 351445410)
Lancellotti P, Lebrun F, Piérard LA. Determinants of exercise-induced changes in mitral regurgitation in patients with coronary artery disease and left ventricular dysfunction. J Am Coll Cardiol 2003;42:1921-8. (Pubitemid 37485566)
Marwick TH, Lancellotti P, Pierard L. Ischaemic mitral regurgitation: mechanisms and diagnosis. Heart 2009;95:1711-8.
Agricola E, Oppizzi M, Pisani M, Meris A, Maisano F, Margonato A. Ischemic mitral regurgitation: mechanisms and echocardiographic classification. Eur J Echocardiogr 2008;9:207-21. (Pubitemid 351665190)
Caldarera I, Van Herwerden LA, Taams MA, Bos E, Roelandt JR. Multiplane transoesophageal echocardiography and morphology of regurgitant mitral valves in surgical repair. Eur Heart J 1995;16:999-1006.
Lancellotti P, Marwick T, Pierard LA. How to manage ischaemic mitral regurgitation. Heart 2008;94:1497-502.
Omran AS,Woo A, David TE, Feindel CM, Rakowski H, Siu SC. Intraoperative transesophageal echocardiography accurately predicts mitral valve anatomy and uitability for repair. J Am Soc Echocardiogr 2002;15:950-7.
Kongsaerepong V, Shiota M, Gillinov AM, Song JM, Fukuda S, McCarthy PM et al. Echocardiographic predictors of successful versus unsuccessful mitral valve repair in ischemic mitral regurgitation. Am J Cardiol 2006;98:504-8. (Pubitemid 44162877)
Chaliki HP, Nishimura RA, Enriquez-Sarano M, Reeder GS.Asimplified, practical approach to assessment of severity of mitral regurgitation by Doppler color flow imaging with proximal convergence: validation with concomitant cardiac catheterization. Mayo Clin Proc 1998;73:929-35.
McCully RB, Enriquez-Sarano M, Tajik AJ, Seward JB. Overestimation of severity of ischemic/functional mitral regurgitation by color Doppler jet area. Am J Cardiol 1994; 74:790-3. (Pubitemid 24312972)
Tribouilloy C, ShenWF,Quéré JP, Rey JL, Choquet D, Dufossé Het al. Assessment of severity of mitral regurgitation by measuring regurgitant jet width at its origin with transesophageal Doppler color flow imaging. Circulation 1992;85:1248-53.
Hall SA, Brickner ME, Willett DL, Irani WN, Afridi I, Grayburn PA. Assessment of mitral regurgitation severity by Doppler color flow mapping of the vena contracta. Circulation 1997;95:636-42. (Pubitemid 27063040)
Matsumura Y, Fukuda S, Tran H, Greenberg NL, Agler DA,WadaNet al. Geometry of the proximal isovelocity surface area in mitral regurgitation by 3-dimensional color Doppler echocardiography: difference between functional mitral regurgitation and prolapse regurgitation. Am Heart J 2008;155:231-8.
Song JM, Kim MJ, Kim YJ, Kang SH, Kim JJ, Kang DH et al. Three-dimensional characteristics of functional mitral regurgitation in patients with severe left ventricular dysfunction: a real-time three-dimensional colour Doppler echocardiography study. Heart 2008;94:590-6.
Yosefy C, Hung J, Chua S, Vaturi M, Ton-Nu TT, Handschumacher MD et al. Direct measurement of vena contracta area by real-time 3-dimensional echocardiography for assessing severity of mitral regurgitation. Am J Cardiol 2009;104:978-83.
Kahlert P, Plicht B, Schenk IM, Janosi RA, 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;21:912-21.
Enriquez-Sarano M, Miller FA Jr, Hayes SN, Bailey KR, Tajik AJ, Seward JB. Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. J Am Coll Cardiol 1995;25:703-9.
Lancellotti P, Troisfontaines P, Toussaint AC, Piérard LA. Prognostic importance of exercise-induced changes in mitral regurgitation in patients with chronic ischemic left ventricular dysfunction. Circulation 2003;108:1713-7. (Pubitemid 37243659)
Schwammenthal E, Popescu AC, Popescu BA, Freimark D, Hod H, Eldar M et al. Mechanism of mitral regurgitation in inferior wall acute myocardial infarction. Am J Cardiol 2002;90:306-9. (Pubitemid 34804566)
Iwakura K, Ito H, Kawano S, Okamura A, Kurotobi T, Date M et al. Comparison of orifice area by transthoracic three-dimensional Doppler echocardiography versus proximal isovelocity surface area (PISA) method for assessment of mitral regurgitation. Am J Cardiol 2006;97:1630-7. (Pubitemid 43737015)
Dujardin KS, Enriquez-Sarano M, Bailey KR, Nishimura RA, Seward JB, Tajik AJ. Grading of mitral regurgitation by quantitative Doppler echocardiography: calibration by left ventricular angiography in routine clinical practice. Circulation 1997;96: 3409-15. (Pubitemid 27513413)
Tribouilloy C, Shen WF, Rey JL, Adam MC, Lesbre JP. Mitral to aortic velocity-time integral ratio. A non-geometric pulsed-Doppler regurgitant index in isolated pure mitral regurgitation. Eur Heart J 1994;15:1335-9. (Pubitemid 24326052)
Enriquez-Sarano M, Dujardin KS, Tribouilloy CM, Seward JB, Yoganathan AP, Bailey KR et al. Determinants of pulmonary venous flow reversal in mitral regurgitation and its usefulness in determining the severity of regurgitation. Am J Cardiol 1999; 83:535-41. (Pubitemid 29097952)
Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation 2009;119:2718-25.
Badano LP, Muraru D, Enriquez-Sarano M. Assessment of functional tricuspid regurgitation. Eur Heart J 2013; (Epub ahead of print).
Badano LP, Agricola E, Perez de Isla L, Gianfagna P, Zamorano JL. Evaluation of the tricuspid valve morphology and function by transthoracic real-time threedimensional echocardiography. Eur J Echocardiogr 2009;10:477-84.
Muraru D, Badano LP, Sarais C, Solda E, Iliceto S. Evaluation of tricuspid valvemorphology and function by transthoracic three-dimensional echocardiography. Curr Cardiol Rep 2011;13:242-9.
Kim HK, Kim YJ, Park JS, Kim KH, Kim KB, AhnHet al. Determinants of the severity of functional tricuspid regurgitation. Am J Cardiol 2006;98:236-42. (Pubitemid 43977896)
Kwan J, Kim GC, Jeon MJ, Kim DH, Shiota T, Thomas JD et al. 3D geometry of a normal tricuspid annulus during systole: a comparison study with the mitral annulus using real-time 3D echocardiography. Eur J Echocardiogr 2007;8:375-83. (Pubitemid 47342372)
Matsunaga A, Duran CM. Progression of tricuspid regurgitation after repaired functional ischemic mitral regurgitation. Circulation 2005;112:1453-7.
Fukuda S, Gillinov AM, McCarthy PM, Stewart WJ, Song JM, Kihara T et al. Determinants of recurrent or residual functional tricuspid regurgitation after tricuspid annuloplasty. Circulation 2006;114:1582-7.
Gonzalez-Vilchez F, Zarauza J, Vazquez de Prada JA, Mart́n Durán R, Ruano J, Delgado C et al. Assessment of tricuspid regurgitation by Doppler color flow imaging: angiographic correlation. Int J Cardiol 1994;44:275-83. (Pubitemid 24182097)
Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Tajik AJ, Seward JB. Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study. J Am Coll Cardiol 2000;36:472-8. (Pubitemid 30624010)
Velayudhan DE, Brown TM, Nanda NC, Patel V, Miller AP, Mehmood F et al. Quantification of tricuspid regurgitation by live three-dimensional transthoracic echocardiographic measurements of vena contracta area. Echocardiography 2006;23: 793-800. (Pubitemid 44450538)
Rivera JM, Vandervoort P, Mele D,Weyman A, Thomas JD. Value of proximal regurgitant jet size in tricuspid regurgitation. Am Heart J 1996;131:742-7. (Pubitemid 26116348)
Tribouilloy CM, Enriquez-Sarano M, Capps MA, Bailey KR, Tajik AJ. Contrasting effect of similar effective regurgitant orifice area in mitral and tricuspid regurgitation: a quantitative Doppler echocardiographic study. J Am Soc Echocardiogr 2002;15: 958-65.
Grossmann G, Stein M, Kochs M,Höher M, KoenigW, HombachVet al. Comparison of the proximal flow convergence method and the jet area method for the assessment of the severity of tricuspid regurgitation. Eur Heart J 1998;19:652-9. (Pubitemid 28224689)
Nagueh SF, Kopelen HA, ZoghbiWA. Relation of mean right atrial pressure to echocardiographic and Doppler parameters of right atrial and right ventricular function. Circulation 1996;93:1160-9. (Pubitemid 26087019)
Minagoe S, Rahimtoola SH, Chandraratna PA. Significance of laminar systolic regurgitant flow in patients with tricuspid regurgitation: a combined pulsed-wave, continuous-wave Doppler and two-dimensional echocardiographic study. Am Heart J 1990;119:627-35. (Pubitemid 20098495)
Dini FL, Conti U, Fontanive P, Andreini D, Banti S, Braccini L et al. Right ventricular dysfunction is a major predictor of outcome in patients with moderate to severe mitral regurgitation and left ventricular dysfunction. Am Heart J 2007;154:172-9. (Pubitemid 46920480)
Messika-Zeitoun D, Thomson H, Bellamy M, Scott C, Tribouilloy C, Dearani J et al. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Cardiovasc Surg 2004;128:296-302. (Pubitemid 38969813)
Haddad F, Doyle R, Murphy DJ, Hunt SA. Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure. Circulation 2008;117:1717-31. (Pubitemid 351482595)
Peluso D, Badano LP, Muraru D, Dal Bianco L, Cucchini U, Kocabay G et al. Right atrial size and function assessed with three-dimensional and speckle-tracking echocardiography in 200 healthy volunteers. Eur Heart J Cardiovasc Imaging 2013 (Epub ahead of print).
