To summarize the problems and improvements in the quantitative assessment of mitral regurgitation (MR) by echocardiography.

We retrospectively analyzed the image sequences of 196 patients who underwent MR evaluation by echocardiography from August 2021 to April 2023 at the Renmin Hospital of Wuhan University. The patients were divided into a pre-quality control group and a post-quality control group. The control group consisted of 107 patients who underwent MR evaluation between August 2021 and August 2022, while the observation group consisted of 89 patients who underwent MR between September 2022 and April 2023. According to the 2017 American Society of Echocardiography guidelines and standards, the degree of MR was divided into four grades (mild, moderate, moderate-severe, and severe). The inconsistency between the grade to which four quantitative parameters, namely, vena contracta width (VCW), effective regurgitant orifice area (EROA), regurgitant volume (RVol), and regurgitant fraction (RF), belonged and the degree of regurgitation within each grade group was counted and classified as complete consistency (all 4 parameters were consistent), low inconsistency (1 parameter inconsistent), medium inconsistency (2 parameters inconsistent), and high inconsistency (3 parameters inconsistent). The χ² test was used to compare the differences in inconsistency between various grade groups and before and after quality control. The intraclass correlation coefficient (ICC) was utilized for the repeatability test.

Among the 196 MR patients, there were 31, 35, 51 and 79 cases in the mild group, moderate group, moderate-severe group, and severe group, respectively. In the mild, moderate, moderate-severe, and severe groups, the percentages of complete consistency, low inconsistency, moderate inconsistency, and high inconsistency were 16.13%, 51.61%, 29.03%, and 3.23%, 14.29%, 62.86%, 17.14%, and 5.71%, 0%, 41.18%, 45.10%, and 13.73%, and 68.35%, 18.99%, 10.13%, and 2.53%, respectively. Patients with severe MR had the highest percentage of complete consistency (mild vs moderate vs moderate-severe vs severe: 16.13% vs 14.29% vs 0% vs 68.35%, χ²=79.734, P＜0.001), while the highest percentage of low inconsistency was seen in patients with moderate MR (mild vs moderate vs moderate-severe vs severe: 51.61% vs 62.86% vs 41.18% vs 18.99%, χ²=24.012, P＜0.001). Moderate-severe MR patients had the highest percentage of medium inconsistency (mild vs moderate vs moderate-severe vs severe: 29.03% vs 17.14% vs 45.10% vs 10.13%, χ²=22.427, P＜0.001). The highest percentage of high inconsistency was observed in moderate-severe MR patients, but the difference between groups was not statistically significant (P＞0.05). The percentage of incomplete consistency was significantly lower in the post-quality control group compared to the pre-quality control group (58.43% vs 74.77%, χ²=5.899, P=0.015). All the inter-observer and intra-observer ICCs were higher than 0.9.

When performing the quantitative assessment of MR, patients with severe MR have a higher degree of consistency than the other groups, and quality control is successful in decreasing the inconsistency. Therefore, quality control for quantitative MR assessment needs to be highlighted and popularized.