Validation of a New Score for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

Anwar, Ashraf M.; Attia, Wael M.; Nosir, Youssef F.M.; Soliman, Osama I.I.; Mosad, Mohammed A.; Othman, Munir; Geleijnse, Marcel L.; El-Amin, Ali M.; Ten Cate, Folkert J.

doi:10.1016/j.echo.2009.09.022

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 1 , Pages 13-22, January 2010

Validation of a New Score for the Assessment of Mitral Stenosis Using Real-Time Three-Dimensional Echocardiography

Ashraf M. Anwar, MD
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Wael M. Attia, MD
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Youssef F.M. Nosir, MD, PhD
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Osama I.I. Soliman, MD, PhD
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Mohammed A. Mosad, MSc
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Munir Othman, MD
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Marcel L. Geleijnse, MD, PhD
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
Ali M. El-Amin, MD
- Department of Cardiology, Al-Hussein University Hospital, Al-Azhar University, Cairo, Egypt
Folkert J. Ten Cate, MD, PhD
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Reprint requests: Folkert J. Ten Cate, MD, Thoraxcenter, Department of Cardiology, ’s-Gravendijkwal 230, Ba 302, Erasmus Medical Center, 3015 CE Rotterdam, The Netherlands.

published online 18 November 2009.

Background

The aim of this study was to validate a new real-time three-dimensional echocardiography (RT3DE) score for evaluating patients with mitral stenosis (MS).

Methods

A two-staged study was conducted. In the first stage, the feasibility of a new RT3DE score was assessed in 17 patients with MS. The second stage was planned to validate the RT3DE score in 74 consecutive patients undergoing percutaneous mitral valvuloplasty. The new RT3DE score was constructed by dividing each mitral valve (MV) leaflet into 3 scallops and was composed of 31 points (indicating increasing abnormality), including 6 points for thickness, 6 for mobility, 10 for calcification, and 9 for subvalvular apparatus involvement. The total RT3DE score was calculated and defined as mild (<8), moderate (8-13), or severe (≥14). MV morphology was assessed using Wilkins's score and compared with the new RT3DE score.

Results

In the first stage, the RT3DE score was feasible and easily applied to all patients, with good interobserver and intraobserver agreement. In the second stage, RT3DE improved MV morphologic assessment, particularly for the detection of calcification and commissural splitting. Both scores were correlated for assessment of thickness and calcification (r = 0.63, P < .0001, and r = 0.44, P < .0001, respectively). Predictors of optimal percutaneous mitral valvuloplasty success by Wilkins's score were leaflet calcification and subvalvular apparatus involvement, and those by RT3DE score were leaflet mobility and subvalvular apparatus involvement. The incidence and severity of mitral regurgitation were associated with high-calcification RT3DE score.

Conclusion

The new RT3DE score is feasible and highly reproducible for the assessment of MV morphology in patients with MS. It can provide incremental prognostic information in addition to Wilkins's score.

Keywords: Real-time three-dimensional echocardiography, Mitral stenosis, Percutaneous mitral valvuloplasty, New scoring system