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Contradiction exists on the incremental value of two-dimensional (2D) and 3D transoesophageal echocardiography (TOE) over 2D transthoracic echocardiography (TTE) for the detection of mitral valve (MV) prolapse in readers with different echocardiographic experience. Twenty patients and five healthy persons were retrospectively identified who had undergone 2D-TTE, 2D-TOE and 3D-TOE. Fifteen (75 %) patients had surgical evidence of prolapse of the posterior MV leaflet and five patients (25 %) had a dilated MV annulus without prolapse. Three reader groups with different echocardiographic expertise (novice, trainees, cardiologists) scored thus in total 675 posterior scallops. Overall there was an improvement in agreement and Kappa values from novice to trainees to cardiologists. Diagnostic accuracies of 2D-TOE were higher than those of 2D-TTE mainly in novice readers. The incremental value of 3D-TOE over 2D-TOE was mainly seen in specificities. Time to diagnosis was dramatically reduced from 2D to 3D-TEE in all reader groups (all P < 0.001). 3D-TOE also improved the agreement (+12 to +16 %) and Kappa values (+0.14 to +0.21) in all reader groups for the exact description of P2 prolapse. Differences between readers with variable experience in determining the precise localization and extent of the prolapsing posterior MV scallops exist in particular in 2D-TTE analysis. 3D-TOE analysis was extremely fast compared to the 2D analysis methods and showed the best diagnostic accuracy (mainly driven by specificity) with identification of P1 and P3 prolapse still improving from novice to trainees to cardiologists and provided optimal description of P2 prolapse extent. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare velocity-encoded cine cardiac magnetic resonance (CMR) with an established echocardiographic method for noninvasive measurement of aortic valve area (AVA) using the continuity equation. Methods and Results: Twenty consecutive young adults with stenotic bicuspid aortic valves were examined with CMR and transthoracic echocardiography (TTE). CMR AVA was calculated by the continuity equation, dividing stroke volume by the aortic velocity-time integral (VTIAorta), the stroke volume measured both by ventricular volume analysis and by phase contrast velocity mapping at 4 levels (1 subvalvar and 3 supravalvar). Stroke volumes measured at all levels correlated well with those from volumetric analysis. The CMR AVAs calculated using volumetric analysis and VTIAorta from jet velocity mapping correlated and agreed well with TTE AVA measurements (R2 = 0.83). When CMR AVA was calculated more rapidly using volume flow and VTIAorta both measured from the same trans-jet velocity acquisition, R2 was 0.74, with a bias and limits of agreement of 0.02 (-0.44, 0.47) cm2. Conclusions: Continuity equation calculation of the AVA using CMR velocity mapping, with or without ventricular volumetric measurement, correlated and agreed well with the comparable and widely accepted TTE approach. [ABSTRACT FROM AUTHOR]