IS 3D TRANSTHORACIC PLANIMETRY STILL SUPERIOR OVER 2D ECHO IN RHEUMATIC MITRAL STENOSIS WHEN BOTH AREA AND HEMODYNAMIC PARAMETERS OF SEVERITY ARE IN QUESTION?

Abstract

Objectives: The objective of the study was to compare transthoracic 3D planimetry to 2D planimetry in calculating mitral valve area along with correlation of various echocardiographic parameters of severity of mitral stenosis among these modalities. Methodology: Patients with (RMS) were enrolled. Keeping 2D PHT as reference mitral valve area (MVA) was calculated and it was compared to the results derived by transthoracic 2D and 3D planimetry. Agreement between the 2D and 3D methods was assessed by measuring the intraclass correlation coefficient (ICC). Results: 51 patients were included. 36 (70.6%) were females; mean age was 33 ± 6 years. Mean gradient was 14.5 ± 3.9 mmhg while mean Pulmonary artery systolic pressure (PASP) was 31.6 ± 6 mmhg. MVA’s derived by PHT, 3D planimetry, and 2D were 1.04 ± 0.24, 1.07 ± 0.24, 1.21 ± 0.27 cm2 respectively. 3D obtained areas were significantly lower compared to 2D (p< 0.001) and insignificantly greater from PHT (p = 0.18). 3D demonstrated best agreement with MVA PHT (95% limits of agreement: 0.67 to 0.92; ICC 0.84). MVA 3D planimetry and MVA 2D correlated well with PASP and mean pressure gradient but showed weak correlation with left atrium size. Conclusion: 3D planimetry derived mitral area compared to 2D echocardiography are more in line with PHT calculated area and correlates well to hemodynamic parameters of severity.