Left Ventricle Study via 3D Full-Volume and Heart-Model Software in Mitral Valve Prolapse With Severe Mitral Regurgitation

Abstract

Background: Most patients with mitral valve prolapse (MVP) are asymptomatic with a normal life expectancy; however, between 5% and 10% of them have progression to severe mitral regurgitation (MR). Because of this silent progression, the size and ejection fraction of the left ventricle are very important in decision-making for surgery in asymptomatic patients with MR. A 3D assessment of LV volumes and ejection fraction is preferred to 2D echocardiography because of its accuracy and reproducibility.<br />Methods: Between April 3, 2018, and February 20, 2019, the present study enrolled 50 patients suffering from MVP with relatively severe MR undergoing transesophageal echocardiography at Rajaie Cardiovascular, Medical, and Research Center, affiliated with Iran University of Medical Sciences. The ejection fraction was analyzed via the visual 2D method, in addition to 3 other methods: the Simpson biplane, 3D full volume, and 3D heart model.<br />Results: Of the 4 measurement methods, the 3D heart model had the highest agreement with the Simpson biplane method (ICC: 0.859, 95% CI: 0.745 to 0.922). The agreement rate between the 3D heart model and the 3D full volume was 72% and between the 3D heart model and the visual 2D method was 64%. In the measurement of the end-diastolic volume, there was a remarkable agreement between the 3D heart model and both the Simpson biplane and 3D full-volume methods (98% and 95%, respectively). Similarly, in the measurement of the end-systolic volume, the rate of agreement between the 3D heart model and both the Simpson biplane and 3D full-volume methods was 91% and 92%, correspondingly.<br />Conclusions: This study showed that the use of the 3D heart model and the Simpson biplane method was more accurate in the study of the left ventricular ejection fraction than that of the visual 2D and 3D full-volume methods. It appears that the use of all 3 methods (ie, the Simpson biplane, 3D full volume, and 3D heart model) in the measurement of the end-systolic and end-diastolic volumes is reliable. (Iranian Heart Journal 2020; 21(2): 41-47)