Mitral Regurgitation (MR) Quantification by PISA

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Data Acquisition


Stroke volume

Reference Values

Mitral Regurgitation Severity
Mild Moderate Severe
RV, mL/beat < 30 30-44 45-59 ≥ 60
RF, % < 30 30-39 40-49 ≥ 50
EROA, cm2 < 0.20 0.10-0.19 0.20-0.29 ≥ 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.


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

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

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

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

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


r Radial distance from orifice when calculating proximal isovelocity hemispheric surface area
Valiasing Aliasing velocity at the radial distance r
Peak VMR Peak velocity of the mitral regurgitant jet
VTIMR Velocity-time integral of the mitral regurgitant jet
RFlow Volume flow rate
LVOT Left ventricular outflow tract
VTILVOT Velocity-time integral of the LVOT
EROA Effective Regurgitant Orifice
RV Regurgitant volume
RF Regurgitant fraction
SV Stroke volume
MR Mitral 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