Mitral Regurgitation (MR) Quantification by PISA

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Data Acquisition


Stroke volume

Reference Values

Mitral Regurgitation Severity
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.


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

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

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

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

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


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


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