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Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()

BACKGROUND: Guidelines for quantifying mitral regurgitation (MR) using “proximal isovelocity surface area” (PISA) instruct operators to measure the PISA radius from valve orifice to Doppler flow convergence “hemisphere”. Using clinical data and a physically-constructed MR model we (A) analyse the ac...

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Autores principales: Moraldo, Michela, Cecaro, Fabrizio, Shun-Shin, Matthew, Pabari, Punam A., Davies, Justin E., Xu, Xiao Y., Hughes, Alun D., Manisty, Charlotte, Francis, Darrel P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819991/
https://www.ncbi.nlm.nih.gov/pubmed/23245796
http://dx.doi.org/10.1016/j.ijcard.2012.11.059
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author Moraldo, Michela
Cecaro, Fabrizio
Shun-Shin, Matthew
Pabari, Punam A.
Davies, Justin E.
Xu, Xiao Y.
Hughes, Alun D.
Manisty, Charlotte
Francis, Darrel P.
author_facet Moraldo, Michela
Cecaro, Fabrizio
Shun-Shin, Matthew
Pabari, Punam A.
Davies, Justin E.
Xu, Xiao Y.
Hughes, Alun D.
Manisty, Charlotte
Francis, Darrel P.
author_sort Moraldo, Michela
collection PubMed
description BACKGROUND: Guidelines for quantifying mitral regurgitation (MR) using “proximal isovelocity surface area” (PISA) instruct operators to measure the PISA radius from valve orifice to Doppler flow convergence “hemisphere”. Using clinical data and a physically-constructed MR model we (A) analyse the actually-observed colour Doppler PISA shape and (B) test whether instructions to measure a “hemisphere” are helpful. METHODS AND RESULTS: In part A, the true shape of PISA shells was investigated using three separate approaches. First, a systematic review of published examples consistently showed non-hemispherical, “urchinoid” shapes. Second, our clinical data confirmed that the Doppler-visualized surface is non-hemispherical. Third, in-vitro experiments showed that round orifices never produce a colour Doppler hemisphere. In part B, six observers were instructed to measure hemisphere radius r(h) and (on a second viewing) urchinoid distance (d(u)) in 11 clinical PISA datasets; 6 established experts also measured PISA distance as the gold standard. r(h) measurements, generated using the hemisphere instruction significantly underestimated expert values (− 28%, p < 0.0005), meaning r(h)(2) was underestimated by approximately 2-fold. d(u) measurements, generated using the non-hemisphere instruction were less biased (+ 7%, p = 0.03). Finally, frame-to-frame variability in PISA distance was found to have a coefficient of variation (CV) of 25% in patients and 9% in in-vitro data. Beat-to-beat variability had a CV of 15% in patients. CONCLUSIONS: Doppler-visualized PISA shells are not hemispherical: we should avoid advising observers to measure a hemispherical radius because it encourages underestimation of orifice area by approximately two-fold. If precision is needed (e.g. to detect changes reliably) multi-frame averaging is essential.
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spelling pubmed-38199912013-11-07 Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()() Moraldo, Michela Cecaro, Fabrizio Shun-Shin, Matthew Pabari, Punam A. Davies, Justin E. Xu, Xiao Y. Hughes, Alun D. Manisty, Charlotte Francis, Darrel P. Int J Cardiol Article BACKGROUND: Guidelines for quantifying mitral regurgitation (MR) using “proximal isovelocity surface area” (PISA) instruct operators to measure the PISA radius from valve orifice to Doppler flow convergence “hemisphere”. Using clinical data and a physically-constructed MR model we (A) analyse the actually-observed colour Doppler PISA shape and (B) test whether instructions to measure a “hemisphere” are helpful. METHODS AND RESULTS: In part A, the true shape of PISA shells was investigated using three separate approaches. First, a systematic review of published examples consistently showed non-hemispherical, “urchinoid” shapes. Second, our clinical data confirmed that the Doppler-visualized surface is non-hemispherical. Third, in-vitro experiments showed that round orifices never produce a colour Doppler hemisphere. In part B, six observers were instructed to measure hemisphere radius r(h) and (on a second viewing) urchinoid distance (d(u)) in 11 clinical PISA datasets; 6 established experts also measured PISA distance as the gold standard. r(h) measurements, generated using the hemisphere instruction significantly underestimated expert values (− 28%, p < 0.0005), meaning r(h)(2) was underestimated by approximately 2-fold. d(u) measurements, generated using the non-hemisphere instruction were less biased (+ 7%, p = 0.03). Finally, frame-to-frame variability in PISA distance was found to have a coefficient of variation (CV) of 25% in patients and 9% in in-vitro data. Beat-to-beat variability had a CV of 15% in patients. CONCLUSIONS: Doppler-visualized PISA shells are not hemispherical: we should avoid advising observers to measure a hemispherical radius because it encourages underestimation of orifice area by approximately two-fold. If precision is needed (e.g. to detect changes reliably) multi-frame averaging is essential. Elsevier 2013-09-30 /pmc/articles/PMC3819991/ /pubmed/23245796 http://dx.doi.org/10.1016/j.ijcard.2012.11.059 Text en © 2013 Elsevier Ireland Ltd. https://creativecommons.org/licenses/by-nc-nd/3.0/ Open Access under CC BY-NC-ND 3.0 (https://creativecommons.org/licenses/by-nc-nd/3.0/) license
spellingShingle Article
Moraldo, Michela
Cecaro, Fabrizio
Shun-Shin, Matthew
Pabari, Punam A.
Davies, Justin E.
Xu, Xiao Y.
Hughes, Alun D.
Manisty, Charlotte
Francis, Darrel P.
Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()
title Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()
title_full Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()
title_fullStr Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()
title_full_unstemmed Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()
title_short Evidence-based recommendations for PISA measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()
title_sort evidence-based recommendations for pisa measurements in mitral regurgitation: systematic review, clinical and in-vitro study()()
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819991/
https://www.ncbi.nlm.nih.gov/pubmed/23245796
http://dx.doi.org/10.1016/j.ijcard.2012.11.059
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