Mitral Regurgitation (MR) Quantification by Volumetric Method

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Data Acquisition

LV Stroke volume

 

MV stroke volume

Reference Values

Mitral Regurgitation Severity
MildModerateSevere
RV, mL/beat< 3030-4445-59≥ 60
RF, %< 3030-3940-49≥ 50
EROA, cm2< 0.200.10-0.190.20-0.29≥ 0.40

 

Discrepancies among EROA, RF, and RVol may arise in the setting of low or high flow states.

 

Algorithm for the integration of multiple parameters of MR severity1

Mitral regurgitation algorithm

Good-quality echocardiographic imaging and complete data acquisition are assumed. If imaging is technically difficult, consider TEE or CMR. MR severity may be indeterminate due to poor image quality, technical issues with data, internal inconsistency among echo findings, or discordance with clinical findings.

Formulas

\[SV_{Forward} = \pi  (\frac{LVOT\hspace{0.1cm}∅}{2})^2 \times VTI_{LVOT}\]

\[SV_{Total} = \pi (\frac{Mitral\hspace{0.1cm}Annulus\hspace{0.1cm}∅}{2})^2 \times  VTI_{MV}\]

or

\[SV_{Total} = LVEDV-LVESV\]

\[MR\hspace{0.1cm}RV = SV_{Total} – SV_{Forward}\]

\[MR\hspace{0.1cm}RF = \frac{MR\hspace{0.1cm}RV}{SV_{Forward}} \times  100\]

Definitions

LVLeft ventricle
LVEDVLeft ventricular end-diastolic volume
LVESVLeft ventricular end-systolic volume
VTIVelocity-time integral
LVOTLeft ventricular outflow tract diameter
MVMitral valve
SVStroke volume
MRMitral regurgitation
RVRegurgitant volume
RFRegurgitant fraction

Reference

1.Zoghbi WA, et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation. A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017 Apr;30(4):303-371. Full text

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Developer & Illustrator: Sirikarn Napan, MD, FACC