Severity of Mitral and Aortic Regurgitation as Assessed by Cardiovascular Magnetic Resonance: Optimizing Correlation with Doppler Echocardiography

Gelfand, Eli V.; Hughes, Sean G; Hauser, Thomas H.; Yeon, Susan B.; Goepfert, Lois; Kissinger, Kraig V.; Rofsky, Neil M.; Manning, Warren J.

doi:10.1080/10976640600604856

Cited by 225 publications

(134 citation statements)

References 28 publications

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“…An RF of ≤15% was graded I (mild), 16% to 30% was graded II (moderate), 31% to 50% was graded III (moderate to severe), and >50% was graded IV (severe) AR according to the standard grading criteria. 13,21 A calculated RF<1% was classified as no AR (grade 0).…”

Section: Mri Analysismentioning

confidence: 99%

“…[13][14][15][16] Compared with the evaluation of AR by echocardiography, MRI is more sensitive in patients with paravalvular, eccentric, or multiple jets like those frequently observed after TAVI. 17 We therefore sought to evaluate LV function, LV remodeling, and the occurrence and evolution of AR in the early and medium-term follow-up after TAVI by using serial cardiac MRI.…”

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confidence: 99%

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Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Merten

Beurich

Zachow

et al. 2013

Circ: Cardiovascular Interventions

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all patients treated with TAVI at our institution were screened for inclusion into this prospective study (n=170; Figure 1). Indication for TAVI was in concordance with the recent consensus statement.18 Data collection was approved by the Institutional Review Board, and all patients signed an informed written consent. Patients with a contraindication to MRI (eg, pre-or post-TAVI pacemakers or MRI incompatible implants) and patients with claustrophobia, severe arrhythmias, or unstable clinical conditions were excluded from the study. Ultimately, a total of 55 consecutive patients treated with TAVI with the use of the 2 currently commercially available bioprostheses (Medtronic CoreValve, Background-Aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) has been associated with poor outcomes, but little is known about how it evolves over time. We evaluated left ventricular (LV) function, remodeling, and the occurrence and evolution of AR after TAVI by using cardiac MRI. Methods and Results-Forty-three patients treated with transfemoral TAVI underwent cardiac MRI 1 week and 6 months after TAVI. LV volumes and function were assessed by using standard cine MRI sequences. Phase-contrast imaging was performed to quantify the degree of AR. The mean age of the evaluated patients was 80 years, and 65% of patients were women. At baseline MRI, the median LV ejection fraction was 58.1%, which improved significantly at follow-up to 63.4% (P<0.0001). A significant reduction of LV end-diastolic volume (149.7±41.4-140.1±43.9 mL; P=0.014) and of LV mass (156.3±32.8-142.7±39.3 g; P<0.001) was observed. Over time, aortic regurgitant fraction increased slightly but significantly from 5.2% to 7.8% (P=0.04). Subgroup analysis revealed that significant changes of LV ejection fraction, volumes, and mass only occurred in patients with no or mild AR at baseline MRI, whereas those parameters remained unchanged in patients with AR more than or equal to grade II. Conclusions-By using cardiac MRI in patients with TAVI, a significant improvement of LV function, volume, and mass can be documented. Mild-to-moderate AR is commonly seen, and AR shows a small increase over time. More-than-mild AR seems to prevent LV functional and structural recovery after TAVI.

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Section: Mri Analysismentioning

confidence: 99%

mentioning

confidence: 99%

Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Merten

Beurich

Zachow

et al. 2013

Circ: Cardiovascular Interventions

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“…Aortic flow was quantified using cross-sectional VENC images with contouring of the aortic lumen to provide a regurgitant fraction (%). Significant aortic regurgitation was defined as a regurgitant fraction >16% 20 . Mitral regurgitant fraction (%) was calculated using the equation: (LV stroke volume aortic stroke volume/LV stroke volume*100.…”

Section: Cmr Protocolmentioning

confidence: 99%

Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: A cardiovascular magnetic resonance study

Dobson

Fairbairn

Musa

et al. 2016

American Heart Journal

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“…41 In patients in whom discrepancy exists between mitral regurgitation severity by clinical findings and echo results, further evaluation with CMR may be helpful. 42 Left heart catheterization, with coronary angiography and ventriculography is indicated in the following circumstances in the evaluation of mitral regurgitation: a) discrepancy between clinical findings and echocardiographic data, b) detection and Table 1 Qualitative and quantitative parameters useful in grading mitral regurgitation severity (from [27] severity assessment of associated valvular lesions and c) presence and extent of coronary artery disease, especially in preparation for surgical intervention. 6 …”

Section: Diagnosis and Evaluation Of Mitral Regurgitationmentioning

confidence: 99%

Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of ‘‘watchful waiting’’ versus ‘‘early surgical intervention’’ for severe, asymptomatic, primary mitral regurgitation are addressed.

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Severity of Mitral and Aortic Regurgitation as Assessed by Cardiovascular Magnetic Resonance: Optimizing Correlation with Doppler Echocardiography

Abstract: The current study provides simple qualititative threshold grades for MR and AR severity that allows for standardized reporting of regurgitation severity by CMR and excellent correlation with clinical echocardiography.

Cited by 225 publications

References 28 publications

Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Aortic Regurgitation and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation

Sex-related differences in left ventricular remodeling in severe aortic stenosis and reverse remodeling after aortic valve replacement: A cardiovascular magnetic resonance study

Primary mitral valve regurgitation: Update and review

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