Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging

Garg, Pankaj; Swift, Andrew J.; Zhong, Liang; Carlhäll, Carl‐Johan; Ebbers, Tino; Westenberg, Jos J.M.; Hope, Michael D.; Bucciarelli-Ducci, Chiara; Bax, Jeroen J.; Myerson, Saul G.

doi:10.1038/s41569-019-0305-z

Cited by 122 publications

(124 citation statements)

References 71 publications

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“…Multiple CMR techniques are used in order to get a detailed description of the condition and a reliable conclusion. 9 …”

Section: Discussionmentioning

confidence: 99%

“…CMR studies have shown that stroke volume (SV) determined in the ascending aorta with 2D PC flow in healthy controls decrease the more distally in the ascending aorta the measurement is performed, 4 5 and the phenomenon is even more pronounced under pathological conditions. 5–8 While a recent consensus statement recommends measuring forward aortic volume at the level of the sinotubular (ST) junction, 9 different measurement locations in the aorta are regularly used ( table 1 ). In some studies, measurements from different locations are used indiscriminately, 10 and some studies do not report the location of flow measurement.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method

et al. 2020

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ObjectiveCardiac MRI is quickly emerging as the gold standard for assessment of mitral regurgitation, most commonly with the indirect method subtracting forward flow in aorta from volumetric segmentation of the left ventricle. We aimed to investigate how aortic flow measurements with increasing distance from the aortic valve affect calculated mitral regurgitations and whether measurements were influenced by breath-hold regimen.MethodsFree-breathing and breath-hold phase contrast flows were measured in aorta at valve level, sinotubular (ST) junction, mid-ascending aorta and in the pulmonary trunk. Flow measurements were pairwise compared, and subsequently, after exclusion of patients with visible mitral and tricuspid regurgitations for left-sided and right-sided comparisons, respectively, flow-measured stroke volumes were compared with ventricular volumetric segmentations.ResultsThirty-nine participants without arrhythmias or structural abnormalities of the large vessels were included. Stroke volumes measured with free-breathing and breath-hold flow decreased equally with increasing distance to the aortic valves (breath-hold flow: aortic valve 105.6±20.8 mL, ST junction 101.5±20.7 mL, mid-ascending aorta 98.1±21.5 mL). After exclusion of atrioventricular regurgitations, stroke volumes determined by volumetric measurements were higher compared with values determined by flow measurements, corresponding to ‘false’ atrioventricular regurgitations of 8.0%±5.8% with flow measured at valve level, 11.6%±5.2% at the ST junction and 15.3%±5.0% at the mid-ascending aorta.ConclusionsStroke volumes determined by flow decrease throughout the proximal aorta and are systematically lower than volumetrically measured stroke volumes. The indirect method systematically overestimates mitral regurgitations, especially with increasing distance from the aortic valves.

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“…Multiple CMR techniques are used in order to get a detailed description of the condition and a reliable conclusion. 9 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method

et al. 2020

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“…Two techniques are employed for MR quantification by CMR: SSFP imaging for LV forward volume and phase contrast imaging for LV forward volume. Unlike echocardiography, which requires the integration of multiple parameters in assessing MR severity, CMR relies on quantitative parameters, mainly RVol and RF [12,20].…”

Section: Cmr In Assessing Chronic Mrmentioning

confidence: 99%

The role of advanced multimodality imaging in chronic mitral regurgitation

Riebel

Agoşton-Coldea

2021

Med Ultrason

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Mitral regurgitation (MR), the second most common valvular heart disease, still constitutes a major diagnostic and thera-peutic challenge, due to its complex nature and to its consequences on cardiac remodelling. Life quality and expectancy are determined by the irreversibility of the left ventricular systolic dysfunction, which, despite current guidelines, remains a major drawback. In order to accurately establish “the point of no return” for left ventricular systolic function, the embedment of clinical, biological and imaging data is a requirement. The purpose of this review is to provide an overview of the current multimodal imaging techniques that are useful in correctly assessing patients with MR. Cardiac magnetic resonance strain imaging techniques and 3D echocardiography, in addition to current echocardiographic criteria may help identify the patients who will benefit from early surgery. The technical development of new transcatheter techniques in mitral valve repair could lead to the extension of current guidelines.

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“…19,26,27 Cardiovascular magnetic resonance imaging Cardiovascular magnetic resonance imaging is clinically useful in the assessment of MR in terms of identification of mechanisms, quantification of severity, and determination of its cardiac consequences on cardiac chamber remodeling. 28 Cardiovascular magnetic resonance imaging is indicated when echocardiography is not adequate to assess MR severity, LV and right ventricular volumes, and systolic function. The advantage of cardiovascular magnetic resonance imaging in revealing the presence, location, and degree of myocardial scar or replacement fibrosis in the atria may play a role in the overall assessment of AFMR.…”

Section: Echocardiographymentioning

confidence: 99%

Atrial functional mitral regurgitation: mechanisms and surgical implications

Fan

Wan

Wong

et al. 2020

Asian Cardiovasc Thorac Ann

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The term atrial functional mitral regurgitation refers to a newly recognized disease entity in which mitral regurgitation occurs secondary to left atrial disease, without left ventricular dilatation and intrinsic mitral valve disease, typically in the setting of long-standing atrial fibrillation. Recent evidence suggests that atrial functional mitral regurgitation is associated with increased risk of death and heart failure re-hospitalization. The etiology, pathophysiology, and mechanism of atrial functional mitral regurgitation is not completely understood but they should not be regarded as the same as for the conventional type of functional mitral regurgitation secondary to left ventricular dilatation and dysfunction. Mitral annular dilatation, atriogenic leaflet distortion, insufficient leaflet remodeling, and subtle left ventricular dysfunction may play a role in the pathogenesis of atrial functional mitral regurgitation. The therapeutic and surgical considerations of atrial functional mitral regurgitation are different from those of ventricular functional mitral regurgitation. In this review, we assess current evidence regarding this new disease entity and propose a new surgical approach based on up-to-date understanding and experience of this condition.

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Assessment of mitral valve regurgitation by cardiovascular magnetic resonance imaging

Cited by 122 publications

References 71 publications

Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method

Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method

The role of advanced multimodality imaging in chronic mitral regurgitation

Atrial functional mitral regurgitation: mechanisms and surgical implications

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