![]() Using appropriate thresholds, LVEIO is a simple and useful method to diagnose severe MR regardless of etiology. Multivariate analysis revealed that LVEIO was an independent predictor for all-cause death only in primary MR. This was found only in primary MR when separate analyses were performed according to etiology. Kaplan-Meier survival analysis revealed high mortality in the group with LVEIO ≥5.4 (P=0.009, hazard ratio 1.833). An optimal LVEIO threshold of 5.4 was determined to distinguish moderate to severe or severe MR from non-severe MR (sensitivity 84%, specificity 91%). MR was classified into 4 groups: Grade 0/1, no, trivial, or mild MR Grade 2, moderate MR Grade 3, moderate to severe MR and Grade 4, severe MR. The records of 18,692 consecutive patients who underwent echocardiography were reviewed. This study determined the optimal LVEIO threshold to assess severe MR with different etiologies and assessed its prognostic value. To all of our readers…don’t be shy about asking questions! We are here to serve you and provide the resources you need to improve your understanding of echo techniques.Recently, the left ventricular early inflow-outflow index (LVEIO), calculated by dividing mitral E-wave velocity by the left ventricular outflow velocity time integral, has been proposed as a simple method for evaluating mitral regurgitation (MR). Since many doctors are familiar with using the numbered grading scale it will be necessary to state if grade III MR is moderate or severe. Grading MR Severity with Echo requires a severity statement (mild, moderate, severe) A sub-category statement using grade I – IV may also be used. For example, ‘Grade III Moderate MR’ or ‘Grade III Severe MR’. Therefore, reporting grade III MR would require an additional statement on severity. But if Grade III secondary MR is called moderate-severe it will continue to under estimate secondary MR because most secondary MR have elliptical-shaped orifices. If Grade III moderate MR is called moderate-severe MR that is probably not a big deal. The ASE MR Quantification Algorithm provides a scale to determine where on the spectrum of severity MR lies when all factors are integrated into the diagnosis process. ![]() Many people consider Grade III MR to mean moderate-to-severe MR. What’s wrong with stating moderate-severe MR? So specific, that if 4 or more of these set criteria are met then the MR is “definitely severe” (ASE, 2017, p332). There are many qualitative and semi-quantitative signs that help indicate the severity of MR with some of these signs considered specific for severe MR. The category of “Grade III” MR is based on quantitative values (EROA, RVol, RF%) but the severity of Grade III MR is influenced by the number of specific severe criteria and the MR orifice shape. ![]() The assessment of MR severity requires an integrated approach incorporating advanced quantification measurements, specific severe criteria, and MR mechanisms. Both the moderate and severe pathways share the same quantitative values (EROA, RVol, and RF%). You will note that Grade III MR values lead to two pathways of either moderate or severe MR. If you do not meet four or more (> 4) of these criteria, it will be necessary to calculate the EROA, RVol, and RF. For MR to meet the criteria of severe, without the need for additional advanced quantification, four or more specific criteria must be met. The quantification algorithm starts by seeing if we can quickly rule-out mild or severe MR. ![]()
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