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)
LA Volume (Biplane Method)Modified Bernoulli EquationStroke Volume, Cardiac Output
LV EF (Dumesnil Method)Myocardial Performance Index (LV)

PISA Method in Quantitating Mitral Regurgitation


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

VFR mL/s
ERO mm2
RVol mL



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
RVol = ERO * VTI

Variable Definition
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)
VFR Volume Flow Rate (mL/s)
ERO Effective Regurgitant Orifice (mm2)
RVol Regurgitant Volume (mL/beat)


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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