Left Ventricle Study via 3D Full-Volume and Heart-Model Software in Mitral Valve Prolapse With Severe Mitral Regurgitation

Document Type: Original Article


1 Faculty of Medicine,Shahid Beheshti University of Medical Sciences,Tehran, IR Iran.

2 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Department of cardiology, Shahid Madani Hospital, Faculty of Medicine,Tabriz University of Medical Sciences,Tabriz, IR Iran.


Background: Most patients with mitral valve prolapse (MVP) are asymptomatic with a normal life expectancy; however, between 5% and 10% of them have progression to severe mitral regurgitation (MR). Because of this silent progression, the size and ejection fraction of the left ventricle are very important in decision-making for surgery in asymptomatic patients with MR. A 3D assessment of LV volumes and ejection fraction is preferred to 2D echocardiography because of its accuracy and reproducibility.
Methods: Between April 3, 2018, and February 20, 2019, the present study enrolled 50 patients suffering from MVP with relatively severe MR undergoing transesophageal echocardiography at Rajaie Cardiovascular, Medical, and Research Center, affiliated with Iran University of Medical Sciences. The ejection fraction was analyzed via the visual 2D method, in addition to 3 other methods: the Simpson biplane, 3D full volume, and 3D heart model.
Results: Of the 4 measurement methods, the 3D heart model had the highest agreement with the Simpson biplane method (ICC: 0.859, 95% CI: 0.745 to 0.922). The agreement rate between the 3D heart model and the 3D full volume was 72% and between the 3D heart model and the visual 2D method was 64%. In the measurement of the end-diastolic volume, there was a remarkable agreement between the 3D heart model and both the Simpson biplane and 3D full-volume methods (98% and 95%, respectively). Similarly, in the measurement of the end-systolic volume, the rate of agreement between the 3D heart model and both the Simpson biplane and 3D full-volume methods was 91% and 92%, correspondingly.
Conclusions: This study showed that the use of the 3D heart model and the Simpson biplane method was more accurate in the study of the left ventricular ejection fraction than that of the visual 2D and 3D full-volume methods. It appears that the use of all 3 methods (ie, the Simpson biplane, 3D full volume, and 3D heart model) in the measurement of the end-systolic and end-diastolic volumes is reliable. (Iranian Heart Journal 2020; 21(2): 41-47)


1. Florentino, T.M., et al., Primary Mitral Valve Regurgitation Outcome in Patients With Severe Aortic Stenosis 1 Year After Transcatheter Aortic Valve Implantation: Echocardiographic Evaluation. Arq Bras Cardiol, 2017: p. 0.
2. Zoghbi, W.A., 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. 30(4): p. 303-371.
3. Freed, L.A., et al., Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med, 1999. 341(1): p. 1-7.
4. Barlow, J.B. and W.A. Pocock, Mitral valve prolapse, the specific billowing mitral leaflet syndrome, or an insignificant non-ejection systolic click. Am Heart J, 1979. 97(3): p. 277-85.
5. Tribouilloy, C., et al., Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction. Eur J Echocardiogr, 2011. 12(9): p. 702-10.
6. Nishimura, R.A., et al., 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 2017. 135(25): p. e1159-e1195.
7. Tribouilloy, C., et al., Survival implication of left ventricular end-systolic diameter in mitral regurgitation due to flail leaflets a long-term follow-up multicenter study. J Am Coll Cardiol, 2009. 54(21): p. 1961-8.
8. Lang, R.M., et al., EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. J Am Soc Echocardiogr, 2012. 25(1): p. 3-46.
9. Mor-Avi, V., et al., Real-time 3-dimensional echocardiographic quantification of left ventricular volumes: multicenter study for validation with magnetic resonance imaging and investigation of sources of error. JACC Cardiovasc Imaging, 2008. 1(4): p. 413-23.
10. Mirinejad, M., Azarfarin, R., Alizadehaslasl, A. Cisatracurium in cardiac surgery - Continuous infusion vs. bolus administration. 2007 Middle East Journal of Anesthesiology.
11. Greupner, J., et al., Head-to-head comparison of left ventricular function assessment with 64-row computed tomography, biplane left cineventriculography, and both 2- and 3-dimensional transthoracic echocardiography: comparison with magnetic resonance imaging as the reference standard. J Am Coll Cardiol, 2012. 59(21): p. 1897-907.
12. Sadeghpour, A., Alizadehasl, A. The right ventricle: A comprehensive review from anatomy, physiology, and mechanics to hemodynamic, functional, and imaging evaluation. 2015 Archives of Cardiovascular Imaging.
13. Habib G., Lancellotti P, Erba PA, Alyavi B et al. The ESC-EORP EURO-ENDO (European Infective Endocarditis) registry. Euro Heart Journal- Quality of care and clinical outcomes. 2019. 5(3):202-207.
14. Sadeghpour A, Alizadehasl A. The right ventricle: A comprehensive review from anatomy physiology and mechanics to thermodynamic, functional imaging evaluation. Archives of cardiovascular imaging. 2015. 3(4):e35717.