Quantification of Single Valve Regurgitation in the Pediatric Population Using 3-Dimensional Echocardiography: Reproducibility and Comparison with Cardiac Magnetic Resonance Imaging.

Routine echocardiographic measurements in clinical practice: reproducibility of left and right ventricular indices and agreement with cardiac magnetic resonance

Routine clinical practice, standard echocardiographic measurements showed overall good reproducibility, with the strongest performance for left ventricular indices.

Multimodality Quantitative Assessment of Left Atrial Remodeling Characteristics Using Echocardiography and LGE-CMR in Isolated Degenerative Mitral Regurgitation: Association With Atrial Fibrillation

Clinical value of RT-3DE in evaluating mitral valve configuration and the occurrence of VFMR in patients with ischemic cardiomyopathy: a clinical investigation.

PURPOSE This study used real-time three-dimensional echocardiography (RT-3DE) to obtain three-dimensional (3D) geometric parameters of the mitral annulus and leaflets, including annular structural indices, leaflet angles, and tenting volume (VTent). We further compared the remodeling patterns between atrial functional mitral regurgitation (AFMR) and ventricular functional mitral regurgitation (VFMR). In addition, RT-3DE combined with speckle tracking imaging (STI) was applied to evaluate structural and functional changes of the left ventricular (LV) and mitral valve (MV) in patients with ischemic cardiomyopathy (ICM) and to identify factors associated with VFMR. METHODS In this cross-sectional observational imaging study, 143 patients diagnosed with ICM admitted between July 2022 and November 2023 were enrolled and classified into a VFMR group (n = 68) and a non-VFMR group (n = 75). Another 53 patients with AFMR and 50 healthy controls were also recruited. MV geometry and LV strain parameters were measured via RT-3DE and STI. Multivariable logistic regression analysis was performed to identify the independent predictors of VFMR. RESULTS Compared with healthy controls, patients with AFMR and VFMR had reduced left ventricular ejection fraction (LVEF), increased LV volumes, and enlarged left atrial diameter. Patients with VFMR presented higher levels of low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG). Both functional mitral regurgitation (FMR) subtypes showed significant alterations in mitral annular and leaflet geometry, with VFMR demonstrating greater annular circularity and VTent. Impaired global longitudinal strain (GLS), reduced LV twist, and increased mitral VTent were identified as independent predictors of VFMR. The combined model incorporating these parameters yielded an area under the curve (AUC) of 0.814, indicating moderate predictive performance. CONCLUSION RT-3DE allows non-invasive evaluation of mitral annular and leaflet geometry and facilitates objective comparison of remodeling patterns between AFMR and VFMR. AFMR is characterized by a larger posterior leaflet angulation, whereas VFMR exhibits more pronounced annular circularity and leaflet tenting. In patients with ICM, impaired LV longitudinal strain, reduced LV twist, and increased VTent are independent factors associated with VFMR. CLINICAL TRIAL NUMBER Not applicable.

Three‐Dimensional Transesophageal Echocardiographic Vena Contracta Area for Grading Mitral Regurgitation: Severity Cut‐offs From a Prospective Tunisian Cohort

ABSTRACT Background Mitral regurgitation (MR) is among the most common valvular heart diseases, but its echocardiographic quantification remains challenging, particularly in secondary MR and in some organic causes. Three‐dimensional vena contracta area (3D VCA) allows direct planimetry of the regurgitant orifice. We aim to compare 3D VCA with two‐dimensional (2D) parameters and to derive aetiology‐specific severity cut‐offs in a Tunisian cohort. Methods Prospective cross‐sectional study. Patients with at least moderate MR underwent transthoracic and 2D/3D transesophageal echocardiography with planimetry of the VCA. Spearman correlations between 3D VCA and 2D parameters (vena contracta width, PISA‐derived regurgitant orifice area), and diagnostic performance for severe MR (ROC, Youden index), were analyzed. Results Ninety‐seven patients were included (mean age 61.6 ± 12.5 years; sex ratio 1.1). MR was primary in 66% (rheumatic 34%, degenerative 31%) and secondary in 34%; jets were mostly single, eccentric and holosystolic, and 62.9% had severe MR. 3D VCA correlated strongly with PISA‐derived orifice area (rho = 0.78) and with vena contracta width (rho = 0.65), particularly in organic, rheumatic, degenerative and eccentric MR. 3D VCA and 2D orifice area identified severe MR with an area under the curve of 0.93; the optimal 3D VCA cut‐off was 0.43 cm2 overall, 0.42 cm2 (rheumatic), 0.55 cm2 (degenerative) and 0.39 cm2 (secondary). Conclusion 3D VCA reliably quantifies MR, provides aetiology‐specific cut‐offs and outperforms 2D methods in complex jets. Multicenter validation is needed, particularly in rheumatic‐endemic regions.

Evaluation of Right Ventricular Size Metrics Measured with Cardiac Magnetic Resonance Imaging in Patients with Pulmonary Regurgitation.

Diagnostic Value of 3D Transesophageal Vena Contracta Area versus 2D Echocardiographic Assessment of Secondary Mitral Regurgitation.

BACKGROUND Secondary mitral regurgitation (MR) is associated with substantial cardiovascular morbidity and mortality, making accurate severity assessment essential for clinical management. Conventional 2D echocardiography has important limitations, particularly in the presence of noncircular regurgitant orifices. Three-dimensional transesophageal echocardiography (3D-TEE) enables direct measurement of Vena Contracta area (VCA) and may provide more accurate quantification of MR severity. AIM OF THE WORK To assess the diagnostic value of three-dimensional transesophageal Vena Contracta area versus two-dimensional echocardiographic assessment of secondary mitral regurgitation. METHODS This study included 52 patients with moderate-to-severe secondary MR, recruited at Alzahraa University Hospital between December 2024 and January 2026. All patients underwent TTE followed by TEE. MR severity was assessed according to current echocardiographic guidelines using an integrative approach that included qualitative, semi-quantitative, and quantitative assessments. Three-dimensional VCA was measured by both TTE and TEE using multiplanar reconstruction. Statistical analysis was performed using Jamovi version 2.3.28 for Windows, with P-values < 0.05 considered statistically significant. RESULTS The mean age of the patients studied was 58.08 ± 9.52 years, with a male-to-female ratio of 43:9. The mean PISA-derived EROA for patients with severe MR was 0.36 ± 0.09 cm2, and the mean regurgitant volume for these patients was 48.6 ± 6.79 mL. VCA measured by 3D TTE (0.69 ± 0.16 cm2) showed a strong positive correlation with 3D TEE VCA (0.67 ± 0.16 cm2) (r = 0.857, p < 0.001). Bland-Altman analysis demonstrated minimal bias (0.035 cm2) and good agreement between both techniques. ROC analysis showed good diagnostic accuracy for severe MR, with slightly higher accuracy for TEE VCA (AUC = 0.874) compared with TTE VCA (AUC = 0.841). CONCLUSION Three-dimensional TEE-derived Vena Contracta area (3D TEE VCA) is a reliable and accurate method for assessing the severity of secondary mitral regurgitation. The strong correlation and good agreement between 3D TEE and 3D TTE VCA measurements, as well as their correlation with PISA-derived EROA, support the value of 3D VCA as a robust quantitative parameter. Moreover, our findings suggest that 3D TTE VCA may represent a feasible, less invasive alternative in selected patients; however, its use as a replacement for TEE warrants confirmation in larger multicenter studies with external validation. Larger multicenter studies with external validation are required before it can be considered a replacement for TEE.