The Effect of Systolic Variation of Mitral Regurgitation on Discordance Between Noninvasive Imaging Modalities

Uretsky, Seth; Aldaia, Lillian; Marcoff, Leo; Koulogiannis, Konstantinos; Hiramatsu, Shinichi; Argulian, Edgar; Rosenthal, Mark; Gillam, Linda D.; Wolff, Steven

doi:10.1016/j.jcmg.2019.02.014

Cited by 24 publications

(13 citation statements)

References 22 publications

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“…Also, the use of constant EROA ignores the variation that occurs even in the context of late-systolic MR, as shown in a recent study. 8 The volumetric method predicts Rvol indirectly using the difference between LV stroke volume and aortic forward flow volume. This indirect approach can, in theory, overcome the aforementioned limitations, but each component has intrinsic error.…”

Section: Discussionmentioning

confidence: 99%

Complicated Double-Orifice Mitral Regurgitation: Combined Hemodynamic Assessment Using Echocardiography and Four-Dimensional Flow Magnetic Resonance Imaging

Lee

Hangouche

Gupta

et al. 2020

CASE

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Section: Discussionmentioning

confidence: 99%

Complicated Double-Orifice Mitral Regurgitation: Combined Hemodynamic Assessment Using Echocardiography and Four-Dimensional Flow Magnetic Resonance Imaging

Lee

Hangouche

Gupta

et al. 2020

CASE

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“…They concluded that there is significant variation of the mitral regurgitant rate even among patients with holosystolic MR jets and concluded that quantitative ways of assessing MR as suggested above via CMR effectively take into consideration this important confounding factor. A subsequent multicenter study determined that systolic variation is one of the factors that accounts for the discordance between echocardiographic and CMR assessment of MR, as the use of the color Doppler jet at a single point in time is the basis of many echocardiographic methods, and hence cannot factor in systolic variation 37,38 …”

Section: Imaging Protocols and Methodology For Assessment Of Mr Via Cmrmentioning

confidence: 99%

“…Quantification of severe MR by either modalities had an “r” value of 0.20‐0.66 with TTE more frequently diagnosing severe MR 11 . Hence, while echocardiography utilizes the visually estimated largest jet of MR, CMR quantitates the entire MR jet independent of the visual assessment leading to more accurate volumetric assessment of MR and its clinical impact on the LV 4,11,38 …”

Section: Comparison Of Cmr With Tte and Its Role In Prognostication Amentioning

confidence: 99%

“…There was low to moderate concordance between the two modalities, with an "r" value of 0.36-0.70. Quantification of severe MR by either modalities had an "r" value of 0.20-0.66 with TTE more frequently diagnosing severe MR. 11 Hence, while echocardiography utilizes the visually estimated largest jet of MR, CMR quantitates the entire MR jet independent of the visual assessment leading to more accurate volumetric assessment of MR and its clinical impact on the LV 4,11,38. Penicka et al in a prospective observational study demonstrated that CMR-derived assessment of primary MR can better identify patients with severe MR and adverse outcomes than echo-derived integrative approach.…”

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confidence: 99%

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A review of the pivotal role of cardiac MRI in mitral valve regurgitation

et al. 2020

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Mitral regurgitation (MR) is the most common valvular heart disorder. 1 About 9% of the general population aged more than 75 years in the United States have MR. As the incidence of MR increases with age, the number of patients with MR who require intervention and inpatient care will only increase in the coming decades. 2 MR is divided into two categories: primary organic MR, which occurs as a result of an intrinsically abnormal mitral valve, and secondary or functional MR, which develops secondary to left ventricular (LV) dysfunction or annular dilatation prohibiting normal valve closure. 3,4 Differentiating between these phenotypes of severe MR by imaging modalities is critical to allow accurate diagnosis as well as guidance in choosing timing and type of intervention. 5 Untreated severe MR is associated with poor outcomes due to the adverse consequences of long-standing volume overload on the left ventricle. It can cause LV volume overload, which may lead to progressive dilatation of the left ventricle and left atrium, heart failure, and pulmonary hypertension. 5,6 Echocardiography and CMR play a complementary role in the diagnosis and understanding the mechanism of MR. They also help define prognosis along with the optimal treatment strategies for MR. 7,8 Decisions regarding surgical interventions, being mitral valve repair or replacement, rely on symptomatology as well as the regurgitation severity, LV ejection fraction (LVEF), and LV end-systolic diameter (LVESD). 9,10 The role of imaging is hence as follows: to identify the etiology of the MR; to quantify the severity of the regurgitation; to assess the response of the left ventricle to the volume overload; and to determine the feasibility of durable repair. 4,5,7,8 Transthoracic echocardiography (TTE) remains the first-line modality per the American Society of Echocardiography(ASE)/American College of Cardiology (ACC)/American Heart Association(AHA) guidelines. The quantitative methods for assessment of MR severity via TTE involve the assessment of several independent data points as indicated in the ASE guidelines which includes flow convergence-based effective regurgitant orifice area (EROA) and regurgitant volume, pulse Doppler-based regurgitant volume, and the vena contracta. 4,11-14 Many assumptions underlie the assessment of MR by echocardiography, and hence, this assessment has limitations which arise from mitral regurgitation characteristics such as temporal change in orifice geometry, the possibility of multiple jets, the

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“…A subsequent multicenter study determined that systolic variation is one of the factors that accounts for the discordance between echocardiographic and CMR assessment of MR, as the use of the color Doppler jet at a single point in time is the basis of many echocardiographic methods, and hence cannot factor in systolic variation. (34,35)Qualitative assessment of mitral valve anatomy and MR: When assessing mitral valve anatomy, the anterior and posterior leaflets, the annulus, the subvalvular apparatus (papillary muscles), and LV contractility including any regional wall motion abnormalities, are carefully visually assessed and their pathophysiology is commented upon. Abnormal leaflet morphology includes thickening, calcification, redundancy, perforation, vegetations, other masses and clefts.…”

Section: Imaging Protocols and Methodology For Assessment Of Mr Via Cmrmentioning

confidence: 99%

Pivotal role of cardiac MRI in mitral valve regurgitation

Gajjar¹,

Kashyap²,

Badlani³

et al. 2020

Preprint

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Cardiac imaging is the cornerstone of defining the etiology, quantification and management of mitral regurgitation (MR). This continues to be even more so the case with emerging trans-catheter techniques to manage MR. Transthoracic echocardiography remains the first line imaging modality to assess MR but has limitations. Cardiac MRI(CMR) provides the advantages of quantitative non-visual estimation, 3D volumetric data, late gadolinium, T1 and extracellular volume measurements to comprehensively assess mitral valvular pathology, cardiac remodeling and the prognostic impact of therapies. This review describes the superiority, technical aspects and growing evidence behind CMR, and lays the roadmap for the future of CMR in MR.

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The Effect of Systolic Variation of Mitral Regurgitation on Discordance Between Noninvasive Imaging Modalities

Cited by 24 publications

References 22 publications

Complicated Double-Orifice Mitral Regurgitation: Combined Hemodynamic Assessment Using Echocardiography and Four-Dimensional Flow Magnetic Resonance Imaging

Complicated Double-Orifice Mitral Regurgitation: Combined Hemodynamic Assessment Using Echocardiography and Four-Dimensional Flow Magnetic Resonance Imaging

A review of the pivotal role of cardiac MRI in mitral valve regurgitation

Pivotal role of cardiac MRI in mitral valve regurgitation

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