{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:53:56Z","timestamp":1777949636259,"version":"3.51.4"},"reference-count":29,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T00:00:00Z","timestamp":1721779200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National University of Singapore","award":["MOH-001368-00"],"award-info":[{"award-number":["MOH-001368-00"]}]},{"name":"Singapore Ministry of Health National Medical Research Council","award":["MOH-001368-00"],"award-info":[{"award-number":["MOH-001368-00"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Net atrioventricular compliance (Cn) can affect the accuracy of mitral valve area (MVA) assessment. We assessed how different methods of MVA assessment are affected by Cn, and if patients with abnormal Cn may be identified by clinical and\/or echocardiographic parameters. Methods: We studied 244 patients with rheumatic MS. The concordance between mitral valve area (MVA) by 2D planimetry, pressure half-time (PHT), continuity equation (CE), Yeo\u2019s index, and 3-dimensional mitral valve area assessed by transesophageal echocardiography (TEE 3DMVA) in patients with normal and abnormal Cn (Cn \u2264 4 mL\/mmHg) were evaluated in the 110 patients with both transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE). Variables that were associated with abnormal Cn were validated in the remaining 134 patients with only TTE. Results: Except for MVA by CE, concordance with TEE 3DMVA was poorer for all other methods of MVA assessment in patients with abnormal Cn. But, the difference in concordance was only statistically significant for MVA by PHT. Patients with MVA \u2264 1.5 cm2 by 2D planimetry and PHT \u2264 130 ms were likely to have an abnormal Cn. (specificity 98.5%). This finding was validated in the remaining 134 patients (specificity 93%). Conclusions: MVA assessment by PHT is significantly affected by Cn. Abnormal Cn should be suspected when 2D planimetry MVA is \u22641.5 cm2 together with an inappropriately short PHT that is \u2264130 ms. In this scenario, MVA by PHT is inaccurate.<\/jats:p>","DOI":"10.3390\/diagnostics14151595","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T10:46:20Z","timestamp":1721817980000},"page":"1595","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Net Atrioventricular Compliance on Mitral Valve Area Assessment\u2014A Perspective Considering Three-Dimensional Mitral Valve Area by Transesophageal Echocardiography"],"prefix":"10.3390","volume":"14","author":[{"given":"Tony","family":"Li","sequence":"first","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Leow","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meei Wah","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William K. F.","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivandito","family":"Kuntjoro","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kian Keong","family":"Poh","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2764-2869","authenticated-orcid":false,"given":"Ching Hui","family":"Sia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiong Cheng","family":"Yeo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre Singapore, 1E Kent Ridge Road, Tower Block Level 9, Singapore 119228, Singapore"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1093\/eurheartj\/ehu449","article-title":"Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: The Global Rheumatic Heart Disease Registry (the REMEDY study)","volume":"36","author":"Engel","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1016\/S0140-6736(09)60994-6","article-title":"Mitral stenosis","volume":"374","author":"Chandrashekhar","year":"2009","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.1161\/CIR.0000000000000029","article-title":"2014 AHA\/ACC Guideline for the Management of Patients with Valvular Heart Disease: Executive summary: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"129","author":"Nishimura","year":"2014","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.echo.2021.02.015","article-title":"Advances in Rheumatic Mitral Stenosis: Echocardiographic, Pathophysiologic, and Hemodynamic Considerations","volume":"34","author":"Silbiger","year":"2021","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/S0735-1097(96)00326-9","article-title":"Measurement of mitral valve area in mitral stenosis: Four echocardiographic methods compared with direct measurement of anatomic orifices","volume":"28","author":"Faletra","year":"1996","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1161\/01.CIR.60.5.1096","article-title":"Noninvasive assessment of atrioventricular pressure half-time by Doppler ultrasound","volume":"60","author":"Hatle","year":"1979","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1161\/01.CIR.38.1.144","article-title":"Atrioventricular pressure half-time. Measure of mitral valve orifice area","volume":"38","author":"Libanoff","year":"1968","journal-title":"Circulation"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1093\/oxfordjournals.eurheartj.a062308","article-title":"A study of the correlation between Doppler and cross-sectional echocardiography in the determination of the mitral valve area","volume":"8","author":"Friart","year":"1987","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1161\/01.CIR.77.1.78","article-title":"Value and limitations of Doppler echocardiography in the quantification of stenotic mitral valve area: Comparison of the pressure half-time and the continuity equation methods","volume":"77","author":"Nakatani","year":"1988","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2008.11.029","article-title":"Echocardiographic assessment of valve stenosis: EAE\/ASE recommendations for clinical practice","volume":"22","author":"Baumgartner","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"131350","DOI":"10.1016\/j.ijcard.2023.131350","article-title":"Yeo\u2019s index: A novel index that combines anatomic and haemodynamic assessment of the severity of mitral stenosis","volume":"392","author":"Leow","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Li, T., Leow, R., Chan, M.W., Kong, W.K.F., Kuntjoro, I., Poh, K.K., Sia, C.H., and Yeo, T.C. (2024). Combining 2D Planimetry and Yeo\u2019s Index Can Help Accurately Identify Patients with Severe Rheumatic Mitral Stenosis-A Perspective from a 3D Assessment Using Transoesophageal Echocardiography. Diagnostics, 14.","DOI":"10.3390\/diagnostics14131440"},{"key":"ref_13","first-page":"101447","article-title":"Validation of Yeo\u2019s index in assessing severity of rheumatic mitral stenosis in mixed valve lesions","volume":"53","author":"Leow","year":"2024","journal-title":"Int. J. Cardiol. Heart Vasc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1016\/0735-1097(92)90284-T","article-title":"Calculation of atrioventricular compliance from the mitral flow profile: Analytic and in vitro study","volume":"19","author":"Flachskampf","year":"1992","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/S0735-1097(87)80290-5","article-title":"Doppler mitral pressure half-time: A clinical tool in search of theoretical justification","volume":"10","author":"Thomas","year":"1987","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1161\/CIRCIMAGING.112.000328","article-title":"Impact of net atrioventricular compliance on clinical outcome in mitral stenosis","volume":"6","author":"Nunes","year":"2013","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.amjcard.2005.03.094","article-title":"Usefulness of measuring net atrioventricular compliance by Doppler echocardiography in patients with mitral stenosis","volume":"96","author":"Li","year":"2005","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1093\/ejechocard\/jeq194","article-title":"Comparison of mitral valve area by pressure half-time and proximal isovelocity surface area method in patients with mitral stenosis: Effect of net atrioventricular compliance","volume":"12","author":"Tanaka","year":"2011","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.echo.2008.11.007","article-title":"Impact of cardiac rhythm on mitral valve area calculated by the pressure half time method in patients with moderate or severe mitral stenosis","volume":"22","author":"Kim","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.echo.2005.07.012","article-title":"Hemodynamic significance of mitral stenosis: Use of a simple, novel index by 2-dimensional echocardiography","volume":"19","author":"Seow","year":"2006","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1037\/0033-2909.86.2.420","article-title":"Intraclass correlations: Uses in assessing rater reliability","volume":"86","author":"Shrout","year":"1979","journal-title":"Psychol. Bull."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2526","DOI":"10.1093\/eurheartj\/ehn022","article-title":"Assessing aortic valve area in aortic stenosis by continuity equation: A novel approach using real-time three-dimensional echocardiography","volume":"29","author":"Poh","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"G87","DOI":"10.1530\/ERP-20-0034","article-title":"The assessment of mitral valve disease: A guideline from the British Society of Echocardiography","volume":"8","author":"Robinson","year":"2021","journal-title":"Echo Res. Pract."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1016\/S000-2914(99)X0064-4","article-title":"Comparison of the usefulness of Doppler pressure half-time in mitral stenosis in patients <65 and > or =65 years of age","volume":"78","author":"Abascal","year":"1996","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/j.ehj.2004.10.001","article-title":"Should mitral valve area assessment in patients with mitral stenosis be based on anatomical or on functional evaluation? A plea for 3D echocardiography as the new clinical standard","volume":"25","author":"Mannaerts","year":"2004","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1355","DOI":"10.1016\/S0735-1097(00)00852-4","article-title":"Improved assessment of mitral valve stenosis by volumetric real-time three-dimensional echocardiography","volume":"36","author":"Binder","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1016\/0002-9149(91)90283-Q","article-title":"Doppler echocardiographic estimation of mitral valve area during changing hemodynamic conditions","volume":"68","author":"Braverman","year":"1991","journal-title":"Am. J. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ijcard.2023.03.058","article-title":"The influence of pectus excavatum on cardiac kinetics and function in otherwise healthy individuals: A systematic review","volume":"381","author":"Sonaglioni","year":"2023","journal-title":"Int. J. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.euje.2006.02.007","article-title":"Evaluation of mitral valve area by the proximal isovelocity surface area method in mitral stenosis: Could it be simplified?","volume":"8","author":"Cachier","year":"2007","journal-title":"Eur. J. Echocardiogr."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/15\/1595\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:22:29Z","timestamp":1760109749000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/15\/1595"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,24]]},"references-count":29,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["diagnostics14151595"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14151595","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,7,24]]}}}