Dynamic quantification of mitral regurgitation

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  • August 11 2025
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Dynamic quantification of mitral regurgitation

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Mitral regurgitation (MR) is the most common valve disease in the USA and China and the second most common in Europe [1-3]. Philips 3D Auto Color Flow Quantification (3D Auto CFQ) provides automated quantification of MV regurgitant volume (RVol), which is one of the strongest outcome predictors [4]. 3D Auto CFQ also determines peak flow rates from 3D color flow (3D CF) images acquired during transesophageal echocardiography (TEE) exams.

At-a-glance:

  • Echocardiography is the most widely used imaging method to evaluate the mitral valve.
  • The most popular method, the proximal isovelocity surface area method, assumes a circular orifice of a constant size and shape. However, the valve is oddly shaped and flow is irregular and dynamic.
  • In contrast, AI-powered Philips 3D Auto CFQ delivers precise measurement of RVol regardless of orifice shape and size.
  • A validation study showed agreement between 3D Auto CFQ and cardiac MR.
AI-based 3D Auto Color Flow Quantification of the mitral valve.

The American Society of Echocardiography (ASE) recommends an integrated approach to mitral valve evaluation that incorporates qualitative, semi-quantitative and qualitative parameters to assess MR severity.

PISA based on inaccurate assumptions

The absolute measurements of effective regurgitant orifice areas (EROA) and regurgitant volume (RVol) are the strongest MR predictors for outcomes [4]. However, the most popular method for measuring EROA and RVol, the proximal isovelocity surface area (PISA) method, assumes that regurgitation occurs though an orifice with a constant size and shape.

3D Auto CFQ provides precise RVol measurements

Philips Automatic 3D Color Flow Quantification (Auto 3D CFQ) reduces this reliance on assumptions when quantifying mitral regurgitation and mostly replaces it with a reliable and robust, AI-driven method that delivers precise measurement of RVol regardless of orifice shape and size.

3D Auto CFQ evaluates the regurgitant flow at every frame in systole, using a model based on the flow of liquid through multiple pinhole orifices. In each frame, the size and shape of the regurgitant orifice is generated by an iterative loop between the model and the 3D CF data.

Study compared 3D Auto CFQ to cardiac MR

A validation study evaluated the performance of 3D Auto CFQ to quantify mitral valve regurgitant volume from 3D TEE clips (averaged across three reviewers) compared to cardiac magnetic resonance assessment for the same subject as acquired withing 24 hours of the echo imaging. 3D Auto CFQ was proven to work on single, multiple, concentric and eccentric jets, and calculated over the entire cardiac cycle, was demonstrated to be equivalent to gold-standard cardiac MRI in the measurement of MV RVol [5].

Read the full white paper here.

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Footnotes
  1. Grave C et al. Fourteen-year temporal trends in patients hospitalized for mitral regurgitation: the increasing burden of mitral valve prolapse in men. JCM. 2022;11:3289
  2. Nkomo VT, et al. Burden of valvular heart diseases: a population-based study. The Lancet. 2006;368:1005-1011.
  3. Reed GW, Bakaeen FG. Valvular heart disease in China. JACC: Asia. 2022;2:366-368.
  4. Zohbig, WA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation. Journal of the American Society of Echocardiography. 2017;30:303-371.
  5. Biner S, et al. Reproducibility of proximal isovelocity surface area, vena contracta, and regurgitant jet area for assessment of mitral regurgitation severity. JACC: Cardiovascular Imaging. 2010;3:235–243.
Disclaimer
Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions. Results in other cases may vary.