Is There an Alternative Explanation to Post-Mi Emergence of Mitral Regurgitation; A CMR-Lge Observational Study

Bogabathina, Hari; Doyle, Mark; Yamrozik, June; Williams, Ronald; Vido, Diane A; Biederman, Robert W

doi:10.1016/s0735-1097(12)61930-5

Cited by 2 publications

(4 citation statements)

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“…This implies that our understanding of post‐infarct LV remodeling as a passive phenomenon, may in fact be an active pathophysiology with direct valvular inflammation triggered by the local infarct process. 28 There is both basic science and clinical data to show that infarction impairs leaflet growth and causes fibrotic changes in mitral leaflets; insufficient leaflet remodeling relative to the mitral annular and LV changes is independently associated with functional mitral regurgitation severity. 3,53,54 Taken together, these results show that CMR is an important noninvasive imaging modality, not only for risk stratification but also for the individualization of treatment decisions for these complex patients 29 …”

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

confidence: 99%

“…26,27 Additionally, late gadolinium enhancement in CMR in patients with MR can provide supplementary consolidating information about features such as myocardial infarct size as well as the significance of scar involving papillary muscles and mitral valve fibrosis. [28][29][30] We attempt to address the above noted points including the assessment of MR via CMR, comparison to echo as well as prognostic impact and procedural planning of MR via CMR in our review.…”

Section: Strengths Limitationsmentioning

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

confidence: 99%

Section: Strengths Limitationsmentioning

confidence: 99%

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

et al. 2020

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“…(23,24) Additionally, late gadolinium enhancement in CMR in patients with MR can provide additional consolidating information about features such as myocardial infarct size as well as the significance of scarring of papillary muscles and mitral valve fibrosis. (25)(26)(27)…”

Section: What Can Cmr Provide?mentioning

confidence: 99%

“…( 26) Mitral valve enhancement is present in a large number of post myocardial infarction (MI) patients but rarely in non-post-MI patients in one observational study. Post-MI patients with mitral valve enhancement are far more likely to have MR. (25) CMR is the future of imaging in MR: comparison of CMR with TTE and its role in prognostication and procedural planning A factor that significantly impacts the decision of intervening upon mitral valve in the setting of MR is its impact on left ventricular deterioration and the lack of reliable and reproducible markers to assess the same. Many clinicians opt for the strategy of watchful waiting especially in those patients who have no symptoms, or in whom other pathophysiology may be contributing to symptoms in addition to mitral regurgitation.…”

Section: Role Of 4d Cmrmentioning

confidence: 99%

Pivotal role of cardiac MRI in mitral valve regurgitation

Gajjar¹,

Kashyap²,

Badlani³

et al. 2020

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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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Is There an Alternative Explanation to Post-Mi Emergence of Mitral Regurgitation; A CMR-Lge Observational Study

Cited by 2 publications

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

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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