EchocardiographyExercise StressMiscEchocardiography
Aortic Valve Velocity RatioLV EF (Modified Quinones Equation)Myocardial Performance Index (RV)
AVA (Continuity Equation VTI)LV EF (Simplified Quinones Equation)PCWP by E/Ea (Nagueh Formula)
AVA (Continuity Equation VMax)LV Fractional ShorteningPISA (Mitral regurgitation)
dP/dt (LV contractility)LV Mass and LV Mass IndexPISA (Mitral stenosis)
dP/dt (RV contractility)Mitral valve area (PHT)Qp/Qs
Left atrial pressure (MR)Mitral Valvuloplasty Score (MGH)RVSP (TR)
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PISA Method in Quantitating Mitral Regurgitation

Calculation


r cm
Vr cm/s
VMax m/s
VTI cm


VFR mL/s
ERO mm2
RVol mL
Calculate

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Information

Mitral Regurgitation Grade of Severity

ERO (mm2) RVol (mL/beat)
Mild <20 <30
Mild-Moderate 20-29 30-44
Moderate-Severe 30-39 45-59
Severe ≥40 ≥60

PISA (Mitral Regurgitation)

Quantification of mitral regurgitation using the principle of conservation of mass by analyzing the Proximal Isovelocity hemispheric Surface Area of the flow convergence on the ventricular side. This method is more accurate for central regurgitant jets than eccentric jets, and for a circular orifice than a non-circular orifice.

VFR = 2 * π * r2 * Vr
ERO =
VFR
VMax
RVol = ERO * VTI

Variable Definition
Input
2 × π × r2 Proximal isovelocity hemispheric surface area at a radial distance r from the orifice
Vr Aliasing velocity at the radial distance r (cm/s)
VMax Peak velocity of the mitral regurgitant jet (m/s)
VTI VTI of the mitral regurgitant jet (cm)
Output
VFR Volume Flow Rate (mL/s)
ERO Effective Regurgitant Orifice (mm2)
RVol Regurgitant Volume (mL/beat)

References

Zoghbi WA et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional Doppler Echocardiography. J Am Soc Echocardiogr 2003; 16(7):783-5,787.
Enriquez-Sarano M., et al. Effective mitral regurgitation orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. JACC 1995; 23(3):703-9.
Utsonomiya T et al. Doppler color flow "proximal isovelocity surface area" method for estimating volume flow rate: effect of orifice shape and machine factors. JACC 17:1103, 1991.
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