Document Type : Research articles


Cardiovascular Research Center, Shahid Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran


Background: Mitral valve area (MVA) is technically measured using both two-dimensional (2D) planimetry and three-dimensional multiplanar reconstruction (3D-MPR) techniques; however, studies have always overestimated MVA using the former method.
Objectives: This study aimed to assess the correlation between MVA assessed by 2D and 3D techniques and the impact of left atrial volume index (LAVI) on the discrepancy between MVA assessed by two echocardiography techniques.
Methods: The data of 75 patients with moderate to severe mitral stenosis assessed by both 2D planimetry and 3D-MPR techniques were retrospectively reviewed. Clinical and echocardiographic variables were evaluated. Left atrial (LA) volume was determined using the biplane area-length method.
Results: The mean±SD MVA assessed by the 2D and 3D techniques was 1.03±0.24 cm2 and 0.99±0.25 cm2 with a mean discrepancy of 0.04±0.15 cm2, respectively. A strong association was observed between the MVA values assessed by 2D planimetry and 3D-MPR methods (r coefficient =0.817, P<0.001) indicating a slight discrepancy between the two techniques in assessing MVA. The pointed discrepancy was affected by none of the baseline characteristics and LAVI value. There was an adverse association between LAVI value and MVA measured by both 2D planimetry (r coefficient=-0.291, P=0.011) and 3D-MPR (r coefficient=-0.260, P=0.024) techniques.
Conclusion: In contrast to the left atrial dimension, the discrepancy in MVA values assessed by 2D planimetry and 3D-MPR techniques is not influenced by LAVI adjusted for baseline parameters.


  1. Sadeghian H, Rezvanfard M, Jalali A. Measurement of mitral valve area in patients with mitral stenosis by 3D echocardiography: A comparison between direct planimetry on 3D zoom and 3D quantification. Echocardiography. 2019;36(8):1509-14. doi: 10.1111/echo.14397. [PubMed: 31287584].
  2. Uygur B, Celik O, Ustabasioglu FE, Akinci O, Erturk M. Three-dimensional transesophageal echocardiography vs cardiac magnetic resonance in the assessment of planimetric mitral valve area in rheumatic mitral stenosis. Echocardiography. 2018;35(10):1621-5. doi: 10.1111/echo.14096. [PubMed: 29981197].
  3. Toufan M, Aghdam NK. The most accurate method for measurement of mitral valve area in mitral stenosis by direct planimetery three dimensional transesophageal echocardiography (3D TEE). Adv Biosc Clin Med. 2018;6(4):33. doi: 10.7575/aiac.abcmed.v.6n.4p.33.
  4. Wu VC, Takeuchi M. Three-dimensional echocardiography: current status and real-life applications. Acta Cardiol Sin. 2017;33(2):107-18. doi: 10.6515/acs20160818a. [PubMed: 28344414].
  5. Mohamed AA, Omran A, Hussein MA. Assessment of mitral valve area by 3D echocardi-ography in rheumatic mitral stenosis: Validation of offline 3D planimetry measure. J Saudi Heart Assoc. 2013;25:113-72. doi: 10.1016/j.jsha.2013.03.047.
  6. Del Rio JM, Grecu L, Nicoara A. Right ventricular function in left heart disease. Semin Cardiothorac Vasc Anesth. 2019;23(1):88-107. doi: 10.1177/1089253218799345.
  7. El Sabbagh A, Reddy YNV, Barros-Gomes S, Borlaug BA, Miranda WR, Pislaru SV, et al. Low-gradient severe mitral stenosis: hemodynamic profiles, clinical characteristics, and outcomes. J Am Heart Assoc. 2019;8(5):e010736. doi: 10.1161/JAHA.118.010736. [PubMed: 30793648].
  8. Abhayaratna WP, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, et al. Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol. 2006;47(12):2357-63. doi: 10.1016/j.jacc.2006.02.048. [PubMed: 16781359].
  9. Takeuchi M, Kitano T, Nabeshima Y, Otsuji Y, Otani K. Left ventricular and left atrial volume ratio assessed by three-dimensional echocardiography: Novel indices for evaluating age-related change in left heart chamber size. Physiol Rep. 2019;7(23):e14300. doi: 10.14814/phy2.14300. [PubMed: 31814325].
  10. Cho IJ[S1] , Jeong H, Choi JY, Lee SE, Chang HJ. Prognostic Implications of the left atrial volume index in patients with progressive mitral stenosis. J Cardiovasc Imaging. 2019;27(2):122-33. doi: 10.4250/jcvi.2019.27.e20. [PubMed: 30993947].
  11. Bangalore S, Yao SS, Chaudhry FA. Role of left atrial size in risk stratification and prognosis of patients undergoing stress echocardiography. J Am Coll Cardiol. 2007;50(13):1254-62. doi: 10.1016/j.jacc.2007.06.025. [PubMed: 17888843].
  12. Zamorano J, Cordeiro P, Sugeng L, Perez de Isla L, Weinert L, Macaya C, et al. Real-time three-dimensional echocardiography for rheumatic mitral valve stenosis evaluation. An accurate and novel approach. J Am Coll Cardiol. 2004;43(11):2091-6. doi: 10.1016/j.jacc.2004.01.046. [PubMed: 15172418].
  13. Schlosshan D, Aggarwal G, Mathur G, Allan R, Cranney G. Real-time 3D transesophageal echocardiography for the evaluation of rheumatic mitral stenosis. JACC Cardiovasc Imaging. 2011;4(6):580-8. doi: 10.1016/j.jcmg.2010.12.009. [PubMed: 21679891].
  14. Chu JW, Levine RA, Chua S, Poh KK, Morris E, Hua L, et al. Assessing mitral valve area and orifice geometry in calcific mitral stenosis: a new solution by real-time three-dimensional echocardiography. J Am Soc Echocardiogr. 2008;21(9):1006-9. doi: 10.1016/j.echo.2008.05.010. [PubMed: 18620839].
  15. Min SY, Song JM, Kim YJ, Park HK, Seo MO, Lee MS, et al. Discrepancy between mitral valve areas measured by two-dimensional planimetry and three-dimensional transoesophageal echocardiography in patients with mitral stenosis. Heart. 2013;99(4):253-8. doi: 10.1136/heartjnl-2012-302742. [PubMed: 23125249].
  16. Cho IJ, Jeong H, Choi JY, Lee SE, Chang HJ. Prognostic implications of the left atrial volume index in patients with progressive mitral stenosis. J Cardiovasc Imaging. 2019;27(2):122-33. doi: 10.4250/jcvi.2019.27.e20. [PubMed: 30993947].