Certain criteria from the American Society of Echocardiography (ASE) guidelines, such as pulmonary vein systolic reversal and left ventricle (LV) remodeling parameters, are "highly specific" for diagnosing severe mitral regurgitation (MR) even when less than four criteria are present, according to a recent study published in JACC: Cardiovascular Imaging.

K. Carlos El-Tallawi, MD, et al., included 177 patients (median age 62 years, 55% men) undergoing near-simultaneous cardiac magnetic resonance (CMR) and transthoracic echocardiography (TTE) for MR assessment. They classified MR severity with a four-grade scale based on CMR-derived regurgitant volume as well as the ASE algorithm.

Overall, 73% of patients had primary MR, 42% had mitral valve prolapse and 25% had flail leaflets. Exact agreement between TTE and CMR for MR grading was observed in 51% of cases – 89% of cases saw agreement within one grade. Patients with any ASE severe MR criteria present were mostly classified as either MR grades three to four by CMR.

Pulmonary vein flow reversal, enlarged LV with normal systolic function, proximal isovelocity surface area radius ≥1 cm and vena contracta width (VCW) ≥0.7 cm – all ASE parameters – showed high specificity for identifying grade four MR by CMR (specificity 88%, 85%, 83% and 80%, respectively). The combination of color Doppler with pulmonary vein systolic reversal or enlarged LV with normal function saw even greater specificity (91% to 95%).

The authors note that reliance on fewer ASE criteria enhanced diagnostic efficiency, reducing the need for quantification. "Combining two of the specific and more accurate MR parameters resulted in a very high specificity, whereas adding a third parameter did not significantly improve accuracy," write the authors.

"Our study demonstrates that the predictive value of these echocardiogram/Doppler parameters varies," they add. "Among echocardiogram Doppler parameters, color Doppler (PISA radius and VCW), pulmonary vein systolic reversal, and LV remodeling parameters ... were highly specific both individually and in combination."