Mitral Regurgitation (MR) Quantification by PISA

– share this tool –

Data Acquisition

MR PISA

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

\[RFlow = 2 \pi r^2 \times V_{aliasing}\]

\[EROA = \frac{RFlow}{Peak\hspace{0.1cm}V_{MR}}\]

\[MR\hspace{0.1cm}RV = EROA \times VTI_{MR}\]

\[SV = 2 \pi (\frac{LVOT}{2})^2 \times VTI_{LVOT} \]

\[RF = \frac{RVol}{SV}\]

Definitions

rRadial distance from orifice when calculating proximal isovelocity hemispheric surface area
ValiasingAliasing velocity at the radial distance r
Peak VMRPeak velocity of the mitral regurgitant jet
VTIMRVelocity-time integral of the mitral regurgitant jet
RFlowVolume flow rate
LVOTLeft ventricular outflow tract
VTILVOTVelocity-time integral of the LVOT
EROAEffective Regurgitant Orifice
RVRegurgitant volume
RFRegurgitant fraction
SVStroke volume
MRMitral regurgitation

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

Disclaimer

We are doing our best to prepare the content of this website. However, Cardiology Connections, Corp cannot warranty the expressions and suggestions of the contents, as well as its accuracy. In addition, to the extent permitted by the law, Cardiology Connections, Corp shall not be responsible for any losses and/or damages due to the usage of the information on our website. Furthermore, the links contained on our website may lead to external sites, which are provided for convenience only. Any information or statements that appeared in these sites are not sponsored, endorsed, or otherwise approved by Cardiology Connections, Corp. For these external sites, Cardiology Connections, Corp cannot be held liable for the availability of, or the content located on or through it. Plus, any losses or damages occurred from using these contents or the internet generally.

Developer & Illustrator: Sirikarn Napan, MD, FACC