Cardiac magnetic resonance assessment of mitral regurgitation severity appears better than echocardiographic imaging

Abolghasemi, Hassan; Algowhary, Magdy; Kishk, Aya Y T; Youssef, Amr Ahmed Aly; Razik, Nady A.

doi:10.1007/s10554-020-01772-1

Cited by 7 publications

(2 citation statements)

References 28 publications

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“…Prior observations potentially explain the variability between cohorts. Uretsky et al [ 37 ] discussed that several observational studies noted patients who underwent mitral correction for echocardiography derived significant MR did not have severe MR on further assessment (with a significant percentage having mild MR) [ 19 , 37 , 40 ], with echocardiography’s comparative suboptimal inter/intra-observer variability and potential to overestimate MR severity deemed potentially contributory [ 19 , 20 , 22 , 37 , 41 – 43 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair

Craven

Chew

Dobson

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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Background When feasible, guidelines recommend mitral valve repair (MVr) over mitral valve replacement (MVR) to treat primary mitral regurgitation (MR), based upon historic outcome studies and transthoracic echocardiography (TTE) reverse remodeling studies. Cardiovascular magnetic resonance (CMR) offers reference standard biventricular assessment with superior MR quantification compared to TTE. Using serial CMR in primary MR patients, we aimed to investigate cardiac reverse remodeling and residual MR post-MVr vs MVR with chordal preservation. Methods 83 patients with ≥ moderate-severe MR on TTE were prospectively recruited. 6-min walk tests (6MWT) and CMR imaging including cine imaging, aortic/pulmonary through-plane phase contrast imaging, T1 maps and late-gadolinium-enhanced (LGE) imaging were performed at baseline and 6 months after mitral surgery or watchful waiting (control group). Results 72 patients completed follow-up (Controls = 20, MVr = 30 and MVR = 22). Surgical groups demonstrated comparable baseline cardiac indices and co-morbidities. At 6-months, MVr and MVR groups demonstrated comparable improvements in 6MWT distances (+ 57 ± 54 m vs + 64 ± 76 m respectively, p = 1), reduced indexed left ventricular end-diastolic volumes (LVEDVi; − 29 ± 21 ml/m2 vs − 37 ± 22 ml/m2 respectively, p = 0.584) and left atrial volumes (− 23 ± 30 ml/m2 and − 39 ± 26 ml/m2 respectively, p = 0.545). At 6-months, compared with controls, right ventricular ejection fraction was poorer post-MVr (47 ± 6.1% vs 53 ± 8.0% respectively, p = 0.01) compared to post-MVR (50 ± 5.7% vs 53 ± 8.0% respectively, p = 0.698). MVR resulted in lower residual MR-regurgitant fraction (RF) than MVr (12 ± 8.0% vs 21 ± 11% respectively, p = 0.022). Baseline and follow-up indices of diffuse and focal myocardial fibrosis (Native T1 relaxation times, extra-cellular volume and quantified LGE respectively) were comparable between groups. Stepwise multiple linear regression of indexed variables in the surgical groups demonstrated baseline indexed mitral regurgitant volume as the sole multivariate predictor of left ventricular (LV) end-diastolic reverse remodelling, baseline LVEDVi as the most significant independent multivariate predictor of follow-up LVEDVi, baseline indexed LV end-systolic volume as the sole multivariate predictor of follow-up LV ejection fraction and undergoing MVR (vs MVr) as the most significant (p < 0.001) baseline multivariate predictor of lower residual MR. Conclusion In primary MR, MVR with chordal preservation may offer comparable cardiac reverse remodeling and functional benefits at 6-months when compared to MVr. Larger, multicenter CMR studies are required, which if the findings are confirmed could impact future surgical practice.

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Section: Discussionmentioning

confidence: 99%

Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair

Craven

Chew

Dobson

et al. 2023

Journal of Cardiovascular Magnetic Resonance

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“…A ecocardiografia, por ter menor acurácia que a ressonância magnética do coração, pode ter atenuado a correlação aqui encontrada, o que pode ser uma limitação deste estudo. 25 Entretanto, se a avaliação da massa ventricular fosse realizada pela ressonância magnética do coração, exame com maior reprodutibilidade, 26 as correlações aqui encontradas seriam estreitadas independentemente de outras variáveis biológicas. Além disso, obtivemos associações estatisticamente significativas com a ecocardiografia, o que supera essa limitação.…”

Section: Discussionunclassified

Associação Entre Índice De Massa Corporal E Massa Ventricular Esquerda Na Doença Renal Crônica Não Dialítica

Filiol Belin,

Latance da Cruz,

da Silva Franco

et al. 2023

Rev Bras Hipertens

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Não há certeza se a obesidade está associada de maneira independente a maior massa ventricular na doença renal crônica (DRC) ou se essa associação depende da elevação da pressão arterial. Nenhum estudo avaliou esse objeto por meio da pressão arterial ambulatorial. Este estudo tem como objetivo investigar se a associação entre o índice de massa corporal e a massa do ventrículo esquerdo é independente dos valores ambulatoriais da pressão arterial na DRC não dialítica. Métodos: Neste estudo observacional transversal, 154 pacientes com DRC não dialítica foram avaliados quanto ao índice de massa corporal (IMC), idade, sexo, etnia, creatinina, pressão arterial ambulatorial, taxa de filtração glomerular e índice de massa do ventrículo esquerdo (IMVE) por ecocardiografia. Resultados: A idade dos pacientes foi de 62 ± 14,8 anos, 83 homens (54%) e 149 brancos. Em um modelo múltiplo ajustado para pressão arterial sistólica (PAS) ambulatorial e taxa de filtração glomerular, foi observada associação positiva entre IMC (R = 0,491; p < 0,001) e IMVE e entre PAS 24h (R = 0,193; p = 0,006) e IMVE. A massa ventricular não se associou com a taxa de filtração glomerular na regressão múltipla (R= - 0,057; p = 0,410). Conclusão: O índice de massa corporal de pacientes com doença crônica não dialítica foi positivamente correlacionado com o índice de hipertrofia ventricular esquerda, mesmo após ajuste para pressão arterial ambulatorial e taxa de filtração glomerular. Esse dado levanta a hipótese de que fatores relacionados à obesidade podem atuar desfavoravelmente sobre o coração, de forma independente e além de sua ação sobre a pressão arterial desses pacientes.

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Diagnostic value of mitral regurgitant jet volume in the assessment of mitral regurgitation severity by general imaging three-dimensional quantification

Wang

Jiang

et al. 2020

Int J Cardiovasc Imaging

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Cardiac magnetic resonance assessment of mitral regurgitation severity appears better than echocardiographic imaging

Cited by 7 publications

References 28 publications

Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair

Cardiac reverse remodeling in primary mitral regurgitation: mitral valve replacement vs. mitral valve repair

Associação Entre Índice De Massa Corporal E Massa Ventricular Esquerda Na Doença Renal Crônica Não Dialítica

Diagnostic value of mitral regurgitant jet volume in the assessment of mitral regurgitation severity by general imaging three-dimensional quantification

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