Clinical Impact of the Volumetric Quantification of Ventricular Secondary Mitral Regurgitation by Three-Dimensional Echocardiography
The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is...
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| Veröffentlicht in: | Journal of the American Society of Echocardiography 2024-04, Vol.37 (4), p.408-419 |
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| creator | Tomaselli, Michele Badano, Luigi P. Oliverio, Giorgio Curti, Emanuele Pece, Cinzia Springhetti, Paolo Milazzo, Salvatore Clement, Alexandra Penso, Marco Gavazzoni, Mara Hădăreanu, Diana R. Mihaila, Sorina Baldea Pugliesi, Giordano M. Delcea, Caterina Muraru, Denisa |
| description | The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is prone to underestimation. Accordingly, we sought to investigate the accuracy of the three-dimensional echocardiography volumetric method (3DEVM) and its association with outcomes in v-SMR patients.
We included 229 patients (70 ± 13 years, 74% men) with v-SMR. We compared EROA and RegVol calculated by the 3DEVM, 2DEVM, and PISA methods. The end point was a composite of heart failure hospitalization and death for any cause.
After a mean follow-up of 20 ±11 months, 98 patients (43%) reached the end point. Regurgitant volume and EROA calculated by 3DEVM were larger than those calculated by 2DEVM and PISA. Using receiver operating characteristic curve analysis, both EROA (area under the curve, 0.75; 95% CI, 0.68-0.81; P = .008) and RegVol (AUC, 0.75; 95% CI, 0.68-0.82; P = .02) measured by 3DEVM showed the highest association with the outcome at 2 years compared to PISA and 2DEVM (P |
| doi_str_mv | 10.1016/j.echo.2024.01.004 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2928586706</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0894731724000075</els_id><sourcerecordid>2928586706</sourcerecordid><originalsourceid>FETCH-LOGICAL-c307t-4fa878880d6f7efc6b6678d84d90413aba7ba743d98c594ce48972b7bbeb07c83</originalsourceid><addsrcrecordid>eNp9kMFq3DAQhkVpaDZpX6CH4mMvdka21pIhl7BNk0BCSZrmKmRpvKvFtjaSXNh7Hzwym-RYEAxovvmZ-Qj5SqGgQOuzbYF644oSSlYALQDYB7Kg0PC85s3yI1mAaFjOK8qPyUkIWwBYCoBP5LgSJWOC8gX5t-rtaLXqs5thp3TMXJfFDWZPrp8GjN7q7H5SY7RdgqJ14ww84Th3pl757DdqNxrl99mdjT7lPOB68msbD3S7zx43HjH_YQccQ_pKyGVaWytvrFt7tdvsP5OjTvUBv7zWU_Ln5-Xj6jq__XV1s7q4zXUFPOasU4ILIcDUHcdO121dc2EEMw0wWqlW8fRYZRqhlw3TyETDy5a3LbbAtahOyfdD7s675wlDlIMNGvtejeimIMumFEtRc6gTWh5Q7V0IHju583ZIZ0oKcrYvt3K2L2f7EqhM9tPQt9f8qR3QvI-86U7A-QHAdOVfi14GbXHUaKxHHaVx9n_5Lz1KmRA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2928586706</pqid></control><display><type>article</type><title>Clinical Impact of the Volumetric Quantification of Ventricular Secondary Mitral Regurgitation by Three-Dimensional Echocardiography</title><source>ScienceDirect Journals (5 years ago - present)</source><creator>Tomaselli, Michele ; Badano, Luigi P. ; Oliverio, Giorgio ; Curti, Emanuele ; Pece, Cinzia ; Springhetti, Paolo ; Milazzo, Salvatore ; Clement, Alexandra ; Penso, Marco ; Gavazzoni, Mara ; Hădăreanu, Diana R. ; Mihaila, Sorina Baldea ; Pugliesi, Giordano M. ; Delcea, Caterina ; Muraru, Denisa</creator><creatorcontrib>Tomaselli, Michele ; Badano, Luigi P. ; Oliverio, Giorgio ; Curti, Emanuele ; Pece, Cinzia ; Springhetti, Paolo ; Milazzo, Salvatore ; Clement, Alexandra ; Penso, Marco ; Gavazzoni, Mara ; Hădăreanu, Diana R. ; Mihaila, Sorina Baldea ; Pugliesi, Giordano M. ; Delcea, Caterina ; Muraru, Denisa</creatorcontrib><description>The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is prone to underestimation. Accordingly, we sought to investigate the accuracy of the three-dimensional echocardiography volumetric method (3DEVM) and its association with outcomes in v-SMR patients.
We included 229 patients (70 ± 13 years, 74% men) with v-SMR. We compared EROA and RegVol calculated by the 3DEVM, 2DEVM, and PISA methods. The end point was a composite of heart failure hospitalization and death for any cause.
After a mean follow-up of 20 ±11 months, 98 patients (43%) reached the end point. Regurgitant volume and EROA calculated by 3DEVM were larger than those calculated by 2DEVM and PISA. Using receiver operating characteristic curve analysis, both EROA (area under the curve, 0.75; 95% CI, 0.68-0.81; P = .008) and RegVol (AUC, 0.75; 95% CI, 0.68-0.82; P = .02) measured by 3DEVM showed the highest association with the outcome at 2 years compared to PISA and 2DEVM (P < .05 for all). Kaplan-Meier analysis demonstrated a significantly higher rate of events in patients with EROA ≥ 0.3 cm2 (cumulative survival at 2 years: 28% ± 7% vs 32% ± 10% vs 30% ± 11%) and RegVol ≥ 45 mL (cumulative survival at 2 years: 21% ± 7% vs 24% ± 13% vs 22% ± 10%) by 3DEVM compared to those by PISA and 2DEVM, respectively. In Cox multivariable analysis, 3DEVM EROA remained independently associated with the end point (hazard ratio, 1.02, 95% CI, 1.00-1.05; P = .02). The model including EROA by 3DEVM provided significant incremental value to predict the combined end point compared to those using 2DEVM (net reclassification index = 0.51, P = .003; integrated discrimination index = 0.04, P = .014) and PISA (net reclassification index = 0.80, P < .001; integrated discrimination index = 0.06, P < .001).
Effective regurgitant orifice area and RegVol calculated by 3DEVM were independently associated with the end point, improving the risk stratification of patients with v-SMR compared to the 2DEVM and PISA methods.
Comparison of 3DEVM, 2DEVM, and PISA to assess MR severity in patients with v-SMR. The 3DEVM-derived EROA and RegVol reclassified v-SMR severity and were associated with a better discriminatory power of patient risk compared to 2DEVM and PISA. (A) Time-dependent ROC curve used to identify the values of EROA (left) and RegVol (right) most closely associated with the composite end point by 3DEVM, 2DEVM, and PISA over a span of 2 years. (B) Spline curve showing the effect of EROA on the composite outcome within the v-SMR cohort. The dashed line showing an RR of 1 represents the average cohort risk of experiencing events. An excess of cardiovascular events (RR > 1) is observed among v-SMR at EROA values of 0.16 cm2, 0.06 cm2, and 0.07 cm2 for 3DEVM, PISA, and 2DEVM, respectively. CSA, Cross-sectional area; LVOT, left ventricular outflow tract; PkVreg, peak velocity of the regurgitant jet; Va, aliasing velocity; VTI, velocity-time integral.
•The assessment of v-SMR severity using the PISA method is prone to underestimation.•EROA and RegVol by 3DEVM were larger values than those obtained by 2DPISA and 2DEVM.•3DEVM has superior discriminative power than 2DPISA and 2DEVM for grading v-SMR</description><identifier>ISSN: 0894-7317</identifier><identifier>EISSN: 1097-6795</identifier><identifier>DOI: 10.1016/j.echo.2024.01.004</identifier><identifier>PMID: 38244817</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Effective regurgitant orifice area ; Heart failure hospitalization ; Left ventricular function ; Prognosis ; Regurgitant volume ; Secondary mitral regurgitation</subject><ispartof>Journal of the American Society of Echocardiography, 2024-04, Vol.37 (4), p.408-419</ispartof><rights>2024 American Society of Echocardiography</rights><rights>Copyright © 2024 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c307t-4fa878880d6f7efc6b6678d84d90413aba7ba743d98c594ce48972b7bbeb07c83</cites><orcidid>0000-0002-0379-3283 ; 0000-0002-3004-2100</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.echo.2024.01.004$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3548,27922,27923,45993</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38244817$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tomaselli, Michele</creatorcontrib><creatorcontrib>Badano, Luigi P.</creatorcontrib><creatorcontrib>Oliverio, Giorgio</creatorcontrib><creatorcontrib>Curti, Emanuele</creatorcontrib><creatorcontrib>Pece, Cinzia</creatorcontrib><creatorcontrib>Springhetti, Paolo</creatorcontrib><creatorcontrib>Milazzo, Salvatore</creatorcontrib><creatorcontrib>Clement, Alexandra</creatorcontrib><creatorcontrib>Penso, Marco</creatorcontrib><creatorcontrib>Gavazzoni, Mara</creatorcontrib><creatorcontrib>Hădăreanu, Diana R.</creatorcontrib><creatorcontrib>Mihaila, Sorina Baldea</creatorcontrib><creatorcontrib>Pugliesi, Giordano M.</creatorcontrib><creatorcontrib>Delcea, Caterina</creatorcontrib><creatorcontrib>Muraru, Denisa</creatorcontrib><title>Clinical Impact of the Volumetric Quantification of Ventricular Secondary Mitral Regurgitation by Three-Dimensional Echocardiography</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is prone to underestimation. Accordingly, we sought to investigate the accuracy of the three-dimensional echocardiography volumetric method (3DEVM) and its association with outcomes in v-SMR patients.
We included 229 patients (70 ± 13 years, 74% men) with v-SMR. We compared EROA and RegVol calculated by the 3DEVM, 2DEVM, and PISA methods. The end point was a composite of heart failure hospitalization and death for any cause.
After a mean follow-up of 20 ±11 months, 98 patients (43%) reached the end point. Regurgitant volume and EROA calculated by 3DEVM were larger than those calculated by 2DEVM and PISA. Using receiver operating characteristic curve analysis, both EROA (area under the curve, 0.75; 95% CI, 0.68-0.81; P = .008) and RegVol (AUC, 0.75; 95% CI, 0.68-0.82; P = .02) measured by 3DEVM showed the highest association with the outcome at 2 years compared to PISA and 2DEVM (P < .05 for all). Kaplan-Meier analysis demonstrated a significantly higher rate of events in patients with EROA ≥ 0.3 cm2 (cumulative survival at 2 years: 28% ± 7% vs 32% ± 10% vs 30% ± 11%) and RegVol ≥ 45 mL (cumulative survival at 2 years: 21% ± 7% vs 24% ± 13% vs 22% ± 10%) by 3DEVM compared to those by PISA and 2DEVM, respectively. In Cox multivariable analysis, 3DEVM EROA remained independently associated with the end point (hazard ratio, 1.02, 95% CI, 1.00-1.05; P = .02). The model including EROA by 3DEVM provided significant incremental value to predict the combined end point compared to those using 2DEVM (net reclassification index = 0.51, P = .003; integrated discrimination index = 0.04, P = .014) and PISA (net reclassification index = 0.80, P < .001; integrated discrimination index = 0.06, P < .001).
Effective regurgitant orifice area and RegVol calculated by 3DEVM were independently associated with the end point, improving the risk stratification of patients with v-SMR compared to the 2DEVM and PISA methods.
Comparison of 3DEVM, 2DEVM, and PISA to assess MR severity in patients with v-SMR. The 3DEVM-derived EROA and RegVol reclassified v-SMR severity and were associated with a better discriminatory power of patient risk compared to 2DEVM and PISA. (A) Time-dependent ROC curve used to identify the values of EROA (left) and RegVol (right) most closely associated with the composite end point by 3DEVM, 2DEVM, and PISA over a span of 2 years. (B) Spline curve showing the effect of EROA on the composite outcome within the v-SMR cohort. The dashed line showing an RR of 1 represents the average cohort risk of experiencing events. An excess of cardiovascular events (RR > 1) is observed among v-SMR at EROA values of 0.16 cm2, 0.06 cm2, and 0.07 cm2 for 3DEVM, PISA, and 2DEVM, respectively. CSA, Cross-sectional area; LVOT, left ventricular outflow tract; PkVreg, peak velocity of the regurgitant jet; Va, aliasing velocity; VTI, velocity-time integral.
•The assessment of v-SMR severity using the PISA method is prone to underestimation.•EROA and RegVol by 3DEVM were larger values than those obtained by 2DPISA and 2DEVM.•3DEVM has superior discriminative power than 2DPISA and 2DEVM for grading v-SMR</description><subject>Effective regurgitant orifice area</subject><subject>Heart failure hospitalization</subject><subject>Left ventricular function</subject><subject>Prognosis</subject><subject>Regurgitant volume</subject><subject>Secondary mitral regurgitation</subject><issn>0894-7317</issn><issn>1097-6795</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kMFq3DAQhkVpaDZpX6CH4mMvdka21pIhl7BNk0BCSZrmKmRpvKvFtjaSXNh7Hzwym-RYEAxovvmZ-Qj5SqGgQOuzbYF644oSSlYALQDYB7Kg0PC85s3yI1mAaFjOK8qPyUkIWwBYCoBP5LgSJWOC8gX5t-rtaLXqs5thp3TMXJfFDWZPrp8GjN7q7H5SY7RdgqJ14ww84Th3pl757DdqNxrl99mdjT7lPOB68msbD3S7zx43HjH_YQccQ_pKyGVaWytvrFt7tdvsP5OjTvUBv7zWU_Ln5-Xj6jq__XV1s7q4zXUFPOasU4ILIcDUHcdO121dc2EEMw0wWqlW8fRYZRqhlw3TyETDy5a3LbbAtahOyfdD7s675wlDlIMNGvtejeimIMumFEtRc6gTWh5Q7V0IHju583ZIZ0oKcrYvt3K2L2f7EqhM9tPQt9f8qR3QvI-86U7A-QHAdOVfi14GbXHUaKxHHaVx9n_5Lz1KmRA</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Tomaselli, Michele</creator><creator>Badano, Luigi P.</creator><creator>Oliverio, Giorgio</creator><creator>Curti, Emanuele</creator><creator>Pece, Cinzia</creator><creator>Springhetti, Paolo</creator><creator>Milazzo, Salvatore</creator><creator>Clement, Alexandra</creator><creator>Penso, Marco</creator><creator>Gavazzoni, Mara</creator><creator>Hădăreanu, Diana R.</creator><creator>Mihaila, Sorina Baldea</creator><creator>Pugliesi, Giordano M.</creator><creator>Delcea, Caterina</creator><creator>Muraru, Denisa</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0379-3283</orcidid><orcidid>https://orcid.org/0000-0002-3004-2100</orcidid></search><sort><creationdate>20240401</creationdate><title>Clinical Impact of the Volumetric Quantification of Ventricular Secondary Mitral Regurgitation by Three-Dimensional Echocardiography</title><author>Tomaselli, Michele ; Badano, Luigi P. ; Oliverio, Giorgio ; Curti, Emanuele ; Pece, Cinzia ; Springhetti, Paolo ; Milazzo, Salvatore ; Clement, Alexandra ; Penso, Marco ; Gavazzoni, Mara ; Hădăreanu, Diana R. ; Mihaila, Sorina Baldea ; Pugliesi, Giordano M. ; Delcea, Caterina ; Muraru, Denisa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c307t-4fa878880d6f7efc6b6678d84d90413aba7ba743d98c594ce48972b7bbeb07c83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Effective regurgitant orifice area</topic><topic>Heart failure hospitalization</topic><topic>Left ventricular function</topic><topic>Prognosis</topic><topic>Regurgitant volume</topic><topic>Secondary mitral regurgitation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tomaselli, Michele</creatorcontrib><creatorcontrib>Badano, Luigi P.</creatorcontrib><creatorcontrib>Oliverio, Giorgio</creatorcontrib><creatorcontrib>Curti, Emanuele</creatorcontrib><creatorcontrib>Pece, Cinzia</creatorcontrib><creatorcontrib>Springhetti, Paolo</creatorcontrib><creatorcontrib>Milazzo, Salvatore</creatorcontrib><creatorcontrib>Clement, Alexandra</creatorcontrib><creatorcontrib>Penso, Marco</creatorcontrib><creatorcontrib>Gavazzoni, Mara</creatorcontrib><creatorcontrib>Hădăreanu, Diana R.</creatorcontrib><creatorcontrib>Mihaila, Sorina Baldea</creatorcontrib><creatorcontrib>Pugliesi, Giordano M.</creatorcontrib><creatorcontrib>Delcea, Caterina</creatorcontrib><creatorcontrib>Muraru, Denisa</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Society of Echocardiography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tomaselli, Michele</au><au>Badano, Luigi P.</au><au>Oliverio, Giorgio</au><au>Curti, Emanuele</au><au>Pece, Cinzia</au><au>Springhetti, Paolo</au><au>Milazzo, Salvatore</au><au>Clement, Alexandra</au><au>Penso, Marco</au><au>Gavazzoni, Mara</au><au>Hădăreanu, Diana R.</au><au>Mihaila, Sorina Baldea</au><au>Pugliesi, Giordano M.</au><au>Delcea, Caterina</au><au>Muraru, Denisa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Impact of the Volumetric Quantification of Ventricular Secondary Mitral Regurgitation by Three-Dimensional Echocardiography</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>37</volume><issue>4</issue><spage>408</spage><epage>419</epage><pages>408-419</pages><issn>0894-7317</issn><eissn>1097-6795</eissn><abstract>The assessment of ventricular secondary mitral regurgitation (v-SMR) severity through effective regurgitant orifice area (EROA) and regurgitant volume (RegVol) calculations using the proximal isovelocity surface area (PISA) method and the two-dimensional echocardiography volumetric method (2DEVM) is prone to underestimation. Accordingly, we sought to investigate the accuracy of the three-dimensional echocardiography volumetric method (3DEVM) and its association with outcomes in v-SMR patients.
We included 229 patients (70 ± 13 years, 74% men) with v-SMR. We compared EROA and RegVol calculated by the 3DEVM, 2DEVM, and PISA methods. The end point was a composite of heart failure hospitalization and death for any cause.
After a mean follow-up of 20 ±11 months, 98 patients (43%) reached the end point. Regurgitant volume and EROA calculated by 3DEVM were larger than those calculated by 2DEVM and PISA. Using receiver operating characteristic curve analysis, both EROA (area under the curve, 0.75; 95% CI, 0.68-0.81; P = .008) and RegVol (AUC, 0.75; 95% CI, 0.68-0.82; P = .02) measured by 3DEVM showed the highest association with the outcome at 2 years compared to PISA and 2DEVM (P < .05 for all). Kaplan-Meier analysis demonstrated a significantly higher rate of events in patients with EROA ≥ 0.3 cm2 (cumulative survival at 2 years: 28% ± 7% vs 32% ± 10% vs 30% ± 11%) and RegVol ≥ 45 mL (cumulative survival at 2 years: 21% ± 7% vs 24% ± 13% vs 22% ± 10%) by 3DEVM compared to those by PISA and 2DEVM, respectively. In Cox multivariable analysis, 3DEVM EROA remained independently associated with the end point (hazard ratio, 1.02, 95% CI, 1.00-1.05; P = .02). The model including EROA by 3DEVM provided significant incremental value to predict the combined end point compared to those using 2DEVM (net reclassification index = 0.51, P = .003; integrated discrimination index = 0.04, P = .014) and PISA (net reclassification index = 0.80, P < .001; integrated discrimination index = 0.06, P < .001).
Effective regurgitant orifice area and RegVol calculated by 3DEVM were independently associated with the end point, improving the risk stratification of patients with v-SMR compared to the 2DEVM and PISA methods.
Comparison of 3DEVM, 2DEVM, and PISA to assess MR severity in patients with v-SMR. The 3DEVM-derived EROA and RegVol reclassified v-SMR severity and were associated with a better discriminatory power of patient risk compared to 2DEVM and PISA. (A) Time-dependent ROC curve used to identify the values of EROA (left) and RegVol (right) most closely associated with the composite end point by 3DEVM, 2DEVM, and PISA over a span of 2 years. (B) Spline curve showing the effect of EROA on the composite outcome within the v-SMR cohort. The dashed line showing an RR of 1 represents the average cohort risk of experiencing events. An excess of cardiovascular events (RR > 1) is observed among v-SMR at EROA values of 0.16 cm2, 0.06 cm2, and 0.07 cm2 for 3DEVM, PISA, and 2DEVM, respectively. CSA, Cross-sectional area; LVOT, left ventricular outflow tract; PkVreg, peak velocity of the regurgitant jet; Va, aliasing velocity; VTI, velocity-time integral.
•The assessment of v-SMR severity using the PISA method is prone to underestimation.•EROA and RegVol by 3DEVM were larger values than those obtained by 2DPISA and 2DEVM.•3DEVM has superior discriminative power than 2DPISA and 2DEVM for grading v-SMR</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38244817</pmid><doi>10.1016/j.echo.2024.01.004</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0379-3283</orcidid><orcidid>https://orcid.org/0000-0002-3004-2100</orcidid></addata></record> |
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| ispartof | Journal of the American Society of Echocardiography, 2024-04, Vol.37 (4), p.408-419 |
| issn | 0894-7317 1097-6795 |
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| source | ScienceDirect Journals (5 years ago - present) |
| subjects | Effective regurgitant orifice area Heart failure hospitalization Left ventricular function Prognosis Regurgitant volume Secondary mitral regurgitation |
| title | Clinical Impact of the Volumetric Quantification of Ventricular Secondary Mitral Regurgitation by Three-Dimensional Echocardiography |
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