Looking for Perfection in the Evaluation of Mitral Regurgitation

Background: Currently, there is no single echocardiographic parameter for assessing the severity of mitral regurgitation. Two conceptually similar methods have been published. One method is the mitral valve to LVOT velocity time integral ratio (MOTVTI), and the other the mitral E wave peak velocity to LVOT velocity time integral ratio (EVTI). Objectives: Our goals were to compare the ability of both methods to diagnose severe mitral regurgitation and establish the best cutoff points for the diagnosis. Methods: We included patients with and without mitral regurgitation. The area under the ROC curve for MOTVTI and EVTI was analyzed to compare their diagnostic ability of both methods and estimate the best diagnostic cutoff points. Results: A total of 135 patients were included in the study, 51 with various degrees of mitral regurgitation and the rest as controls. Patients with severe mitral regurgitation had an effective regurgitant orifice area of 0.73±0.34 cm2, vena contracta of 8.3±2.2 mm and regurgitant volume of 99±42 ml. The analysis showed an area under ROC curve of 0.83 (95% CI: 0.75 to 0.89) for MOTVTI and 0.92 (95% CI: 0.86 to 0.96) for EVTI, without significant differences. The best cutoff point was> 1.84 for MOTVTI (sensitivity 80%, specificity 94%) and >6.25 for EVTI (sensitivity 100%, specificity 79%). Conclusions: Both methods are useful for the diagnosis of severe MR and have similar diagnostic capacity. The best cutoff points differ from those originally published.