Mitral regurgitation
Combines the qualitative findings, vena contracta and PISA into one integrated grade, the way the ASE algorithm reads them.
ASE 2017 guidelines for native valvular regurgitation
How it's calculated
Integration (ASE 2017)
Four or more findings that fit mild MR, without competing severe signs, make MR mild. Four or more findings specific for severe MR make it severe. Anything else is intermediate and is graded from the quantitative values.
Vena contracta: under 3 mm fits mild, 7 mm or more fits severe.
PISA
EROA (cm²) = 2π × r² × Va ÷ Vmax, with r in cm (mm ÷ 10) Regurgitant volume (mL) = EROA × MR VTI Regurgitant fraction = RVol ÷ (RVol + LVOT stroke volume)| Mild | Moderate | Severe | |
|---|---|---|---|
| EROA (cm²) | < 0.20 | 0.20–0.39 | ≥ 0.40 |
| Regurgitant volume (mL) | < 30 | 30–59 | ≥ 60 |
| Regurgitant fraction | < 30% | 30–49% | ≥ 50% |
Moderate is split into mild-to-moderate (EROA 0.20–0.29, RVol 30–44, RF 30–39%) and moderate-to-severe (EROA 0.30–0.39, RVol 45–59, RF 40–49%).
In secondary MR the orifice is often crescent-shaped, so PISA tends to underestimate EROA; a lower value can still mean severe MR when other findings agree. Zoghbi WA, et al. J Am Soc Echocardiogr 2017;30:303–371.
For education and as a reporting aid. A result supports the reading of the full study and does not replace it.