Fact or Artifact: A prospective study on diagnostic value of a new echocardiographic parameter of Color Doppler Horizontal Splay width in assessment of mitral regurgitation severity

Objective. 1. To evaluate the diagnostic value of the echocardiographic parameter of Color Doppler Horizontal Splay width (CDHSW) in assessment the of mitral regurgitation (MR) severity.
2. To determine the cut-off values of CDHSW for the diagnosis of severe MR.
Material and methods. A prospective data collection of 81 patients with presence of CDHS on echocardiography was carried out. Transesophageal echocardiography was performed in all of them to clarify the etiology and severity of MR, and in addition, 33 (40%) patients underwent phase-contrast magnetic resonance imaging.
Results. After multiparametric examination severe MR was found in 32 (39%) patients, moderate MR in 47 (58%) and mild MR in 2 (3%). Regurgitation jet was eccentric in 79 (98%) patients, and sharply eccentric in 58 (71%) of them. The values of CDHSW (measured in 4-chamber, 2-chamber view, and mean CDHSW values) were significantly higher in the group of severe MR in comparison with the group of moderate MR.  A statistically significant strong correlation was revealed between the CDHSW (measured in the 4- and 2-chamber view, and  mean CDHSW values) with the values of MR volume, regurgitant fraction, size of effective regurgitant orifice, and a moderate correlation with the values of  vena contracta width, left ventricle end-diastolic velocity  and left atrium volume. ROC analysis showed the highest diagnostic value (AUC 0,93 ± 0,5, p < 0,001) of mean CDHSW in diagnosis of  severe MR   in comparison with CDHSW. Optimal cutoff value for mean CDHSW for severe MR  diagnosis was >30 mm with a sensitivity of 88% and specificity of 71%.
Conclusions. 1. CDHSW is an echocardiographic parameter that provides additional opportunities in the diagnosis of  latent moderate and severe eccentric MR.
2. It is reasonable to use mean values for the increase of diagnostic sensitivity of CDHSW.
3. The mean value of CDHSW >30 mm is highly suggestive to severe MR. 

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