Journal of Veterinary Internal Medicine
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This study evaluated two echocardiographic methods (volumetric and PISA) for quantifying mitral regurgitation severity in dogs with degenerative mitral valve disease. Both methods effectively distinguished disease stages, but they were not interchangeable due to wide limits of agreement. These quantitative measures provide relevant clinical information for staging and potential surgical planning.
**Background:** Quantitative assessment of mitral regurgitation (MR) severity has become increasingly important as surgical and catheter‐based therapies for MR reduction become available. This study aimed to obtain quantitative measures of MR severity across stages of degenerative mitral valve disease (DMVD) and evaluate agreement between two echocardiographic methods.
**Methods:** 51 client-owned dogs stratified across three stages of DMVD (ACVIM B1, B2, and C) were included. Regurgitant volume (RVol) and fraction (RF) were measured on echocardiograms prospectively acquired by a single cardiologist using Simpson's method of discs (volumetric) and proximal isovelocity surface area (PISA) methods. RVol and RF were compared by both methods across disease stage using Kruskall–Wallis and Conover tests. Agreement between methods over the range of MR severity was determined by Bland-Altman analyses. Intra- and inter-observer measurement variability assessments were made via intraclass correlation coefficients (ICC).
**Key Results:** RVol was different (P < 0.0001) across stage by both volumetric (B1—0.09 mL/kg; B2—1.49 mL/kg; C—2.72 mL/kg) and PISA (B1—0.39 mL/Kg; B2—1.67 mL/kg; C—3.1 mL/kg) methods. Similarly, RF was different (P < 0.0001) across stage by both volumetric (B1—13.6%, B2—55.6%, C—67.2%) and PISA (B1—34.3%, B2—58.8%, C—75.2%) methods. Bias between volumetric and PISA for RVol (0.24 mL/kg) and RF (13.7%) was biologically acceptable; however, the limits of agreement were wide. Proportional bias between methods was not present for RVol (P = 0.79) or RF (P = 0.53). Aside from PISA RF, intra- and inter-observer variability assessments showed ICC greater than 0.81.
**Clinical Implications:** Measurement of RVol and RF provide relevant information on MR severity across ACVIM stages of DMVD. Volumetric and PISA methods are not interchangeable, which is important for clinical decision-making and when comparing results across studies.