P687Practical echocardiographic semi-quantitative scoring system to determine severity of mitral regurgitation


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Abstract

Background: Objective assessment of the severity of mitral regurgitation (MR) is challenging, especially in view of multicenter reserach. We validated a 6-point index (ESC-guidelines based) to determine MR severity in clinical setting.Methods:We retrospectively evaluated 150 patients that underwent routine transthoracic echocardiography with severe (71) or moderate (79) MR (clinical diagnosis). Data were scored positive (1) or negative (0) for severe MR by an expert panel: (1) jet characteristics (≥40% of left atrial surface and/or up to roof), (2) vena contracta (≥0,7 cm), (3) systolic blunting pulmonary vein flow (≥50%), (4) regurgitant volume (≥60 ml), (5) effective regurgitant orifice (≥0,40 cm2), (6) E-wave (≥120 cm/s). ROC analysis was performed using total MR-score (0-6) per patient, and best cut-off value plus corresponding predictive values were calculated.Results:The scoring system showed a significant difference in total score for moderate (1,1±0,99) versus severe (2,2±1,02) MR. ROC analysis revealed an area under the curve of 0.79 and a best cut-off value of ≥2 points for severe MR, with sensitivity 0,73, specificity 0,70, positive predictive value (PPV) 0,68 and negative predictive value (NPV) 0,74. The PPV was 100% in case of ≥5 points, and NPV was 100% for 0 points, provided that as much as possible parameters are obtained. Additional analysis using left atrial size and right sided pressure did not further improve these values.Conclusions: Severe MR is associated with 2 or more positive findings on the 6-point scoring system, whereas moderate MR is suggested in case of 0 or 1. For clinical practice, this easy-to-use semiquantative scoring system is fairly useful in the setting of multicenter research, but expert consensus reading remains necessary for selected cases.

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