TY - JOUR
T1 - An easy-to-use scoring index to determine severity of mitral regurgitation by 2D echocardiography in clinical practice
AU - Jansen, Rosemarijn
AU - Hart, Einar A.
AU - Peters, Max
AU - Urgel, Kim
AU - Kluin, Jolanda
AU - Tietge, Wouter J.
AU - Zwart, Koen
AU - Sybrandy, Kirsten C.
AU - Cramer, Maarten J. M.
AU - Chamuleau, Steven A. J.
PY - 2017
Y1 - 2017
N2 - Purpose: Mitral regurgitation (MR) grading by two-dimensional transthoracic echocardiography is challenging, but important to determine the best treatment strategy in patients with MR. Current guidelines advocate an integrative approach, although no recommendation is provided on how to do so. An easy-to-use index will be helpful for standardized and reproducible MR grading. Methods: Eleven echocardiographic parameters were retrospectively evaluated in 145 patients with moderate or severe MR. Parameters were scored positive or negative for severe MR, where expert panel consensus reading was considered as the reference standard. Logistic regression was performed, and adjusted coefficients were used to create a risk score for severe MR per patient (ROSE-index). The best cutoff with corresponding predictive values was determined. Results: Eighty-two percent of all parameters could be determined. Multivariable analysis revealed five parameters that remained significant predictors for severe MR: morphology, jet characteristics, vena contracta, systolic reversal, and left ventricular dimensions. With different weighing, a total score of 8 could be obtained. Median total ROSE-index score for moderate (2.0) and severe MR (5.0) did significantly differ. The cutoff score (>= 4) revealed sensitivity 0.84 and specificity 0.83 to diagnose severe MR. Negative predictive value was 100% for score 0 and 1; score 6-8 showed a 100% positive predictive value. Inter-and intra-observer agreements were excellent (K-values >0.80). Conclusion: Here, we propose an easy-to-use tool for integrated analysis of guideline parameters to assess MR severity. Using this so-called ROSE-index revealed reliable and reproducible assessment of severe MR (cutoff >= 4) that may be helpful for clinical decision making
AB - Purpose: Mitral regurgitation (MR) grading by two-dimensional transthoracic echocardiography is challenging, but important to determine the best treatment strategy in patients with MR. Current guidelines advocate an integrative approach, although no recommendation is provided on how to do so. An easy-to-use index will be helpful for standardized and reproducible MR grading. Methods: Eleven echocardiographic parameters were retrospectively evaluated in 145 patients with moderate or severe MR. Parameters were scored positive or negative for severe MR, where expert panel consensus reading was considered as the reference standard. Logistic regression was performed, and adjusted coefficients were used to create a risk score for severe MR per patient (ROSE-index). The best cutoff with corresponding predictive values was determined. Results: Eighty-two percent of all parameters could be determined. Multivariable analysis revealed five parameters that remained significant predictors for severe MR: morphology, jet characteristics, vena contracta, systolic reversal, and left ventricular dimensions. With different weighing, a total score of 8 could be obtained. Median total ROSE-index score for moderate (2.0) and severe MR (5.0) did significantly differ. The cutoff score (>= 4) revealed sensitivity 0.84 and specificity 0.83 to diagnose severe MR. Negative predictive value was 100% for score 0 and 1; score 6-8 showed a 100% positive predictive value. Inter-and intra-observer agreements were excellent (K-values >0.80). Conclusion: Here, we propose an easy-to-use tool for integrated analysis of guideline parameters to assess MR severity. Using this so-called ROSE-index revealed reliable and reproducible assessment of severe MR (cutoff >= 4) that may be helpful for clinical decision making
U2 - https://doi.org/10.1111/echo.13636
DO - https://doi.org/10.1111/echo.13636
M3 - Article
C2 - 28833463
SN - 0742-2822
VL - 34
SP - 1275
EP - 1283
JO - Echocardiography (Mount Kisco, N.Y.)
JF - Echocardiography (Mount Kisco, N.Y.)
IS - 9
ER -