Quantification of mitral regurgitation in patients with hypertrophic cardiomyopathy using aortic and pulmonary flow data: impacts of left ventricular outflow tract obstruction and different left ventricular segmentation methods

Śpiewak, Mateusz; Kłopotowski, Mariusz; Gawor, Monika; Kubik, Agata; Kowalik, Ewa; Miłosz-Wieczorek, Barbara; Dąbrowski, M; Werys, Konrad; Mazurkiewicz, Łukasz; Kożuch, Katarzyna; Polańska-Skrzypczyk, Magdalena; Petryka-Mazurkiewicz, Joanna; Klisiewicz, Anna; Bilińska, Zofia T.; Grzybowski, Jacek; Witkowski, Adam; Marczak, Magdalena

doi:10.1186/s12968-017-0417-8

Cited by 11 publications

(12 citation statements)

References 50 publications

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“…While the application of MRI for detecting LVOT obstruction is limited, it is challenging to use objective parameters to evaluate obstruction. Fortunately, previous studies have shown that LVEF, LVMI, and maximum LVWT or average LVWT were significantly higher in obstructive HCM than that in nonobstructive HCM, as in our study, 18,21,22 In this study we further investigated the correlation between LVOT obstruction and these parameters, and the result showed that Average LVWT and Maximum LVWT can serve as independent risk factors for obstruction.…”

Section: Discussionsupporting

confidence: 57%

Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking

She

Guo

et al. 2020

Magnetic Resonance Imaging

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Background: Myocardial strain for assessment of hypertrophic cardiomyopathy (HCM) is of importance and may play a role in identifying obstruction in HCM patients. Purpose: To evaluate the utility of myocardial strain for detecting left ventricular (LV) outflow tract (LVOT) obstruction in HCM patients based on magnetic resonance tissue tracking. Study Type: Retrospective. Population: In all, 44 adult HCM patients with LVOT obstruction and 108 adult HCM patients without LVOT obstruction. Field Strength/Sequence: 1.5 T; Steady-state free-precession cine sequence; phase-sensitive inversion-prepared segmented gradient echo sequence for late gadolinium enhancement (LGE) imaging. Assessment: Strain parameters including the local and global levels of LV myocardium and the subtraction (Sub) of myocardial strain variables between interventricular septal segments (IVSS) and noninterventricular septal segments (NIVSS) were measured for differentiating HCM with obstruction from nonobstruction. Average and maximum LV wall thickness (Average and Maximum LVWT) were also analyzed. Statistical Tests: Univariate and multivariate logistic regression analysis, area under the receiver operating characteristic (ROC) curve (AUC), intraclass correlation coefficient. Results: In multivariate analysis, Average LVWT, Maximum LVWT, and the subtraction of radial peak strain (Sub Radial PS) between NIVSS and IVSS were independently associated with LVOT obstruction. The AUCs were 0.731, 0.840, and 0.890 for Average LVWT, Maximum LVWT, and Sub Radial PS, respectively. Sub Radial PS (cutoff value: 8.1%) demonstrated the highest sensitivity of 75.0% and a high specificity of 87.9% for identifying LVOT; Maximum LVWT (cutoff value: 22.9 mm) showed good sensitivity (72.7%) and specificity (83.3%). Combining Maximum LVWT >22.9 mm and Sub Radial PS > 8.1% achieved a better diagnostic performance (specificity 95.4%, sensitivity 70.5%). Data Conclusion: Combining Maximum LVWT >22.9 mm and Sub Radial PS >8.1% holds promise for objectively evaluating LVOT obstruction in HCM patients with very high specificity and acceptable sensitivity. Level of Evidence: 3 Technical Efficacy Stage: 2

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Section: Discussionsupporting

confidence: 57%

Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking

She

Guo

et al. 2020

Magnetic Resonance Imaging

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“…They used the MR Standard method to quantify the regurgitant volume and demonstrated similar bias (bias = 0 ml, −18 ml to 17 ml) for intraobserver tests. Śpiewak et al have previously demonstrated that the exclusion of papillary muscles and trabeculations from the blood pool and the inclusion of them in the LV mass calculation can lead to significantly lower MR volume than when papillary muscles and trabeculations are included in the blood pool [16]. This discrepancy again limits the clinical translation of both MR Standard and MR LVRV for the quantification of MR between two sites using different methods to LV segmentation.…”

Section: Discussionmentioning

confidence: 99%

Standard and emerging CMR methods for mitral regurgitation quantification

Fidock

Archer

Barker

et al. 2021

International Journal of Cardiology

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Background: There are several methods to quantify mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR). The interoperability of these methods and their reproducibility remains undetermined. Objective: To determine the agreement and reproducibility of different MR quantification methods by CMR across all aetiologies. Methods: Thirty-five patients with MR were recruited (primary MR = 12, secondary MR = 10 and MVR = 13). Patients underwent CMR, including cines and four-dimensional flow (4D flow). Four methods were evaluated: MR Standard (left ventricular stroke volume -aortic forward flow by phase contrast), MR LVRV (left ventricular stroke volume -right ventricular stroke volume), MR Jet (direct jet quantification by 4D flow) and MR MVAV (mitral forward flow by 4D flow -aortic forward flow by 4D flow). For all cases and MR types, 520 MR volumes were recorded by these 4 methods for intra−/inter-observer tests. Results: In primary MR, MR MVAV and MR LVRV were comparable to MR Standard (P > 0.05). MR Jet resulted in significantly higher MR volumes when compared to MR Standard (P < 0.05) In secondary MR and MVR cases, all methods were comparable. In intra-observer tests, MR MVAV demonstrated least bias with best limits of agreement (bias = −0.1 ml, −8 ml to 7.8 ml, P = 0.9) and best concordance correlation coefficient (CCC = 0.96, P < 0.01). In interobserver tests, for primary MR and MVR, least bias and highest CCC were observed for MR MVAV . For secondary MR, bias was lowest for MR Jet (−0.1 ml, P_NS). Conclusion: CMR methods of MR quantification demonstrate agreement in secondary MR and MVR. In primary MR, this was not observed. Across all types of MR, MR MVAV quantification demonstrated the highest reproducibility and consistency.

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“…Downloaded from aorta the measurement is performed, 4 5 and the phenomenon is even more pronounced under pathological conditions. [5][6][7][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: How Might This Impact On Clinical Practice?mentioning

confidence: 99%

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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Quantification of mitral regurgitation in patients with hypertrophic cardiomyopathy using aortic and pulmonary flow data: impacts of left ventricular outflow tract obstruction and different left ventricular segmentation methods

Cited by 11 publications

References 50 publications

Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking

Left Ventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy: The Utility of Myocardial Strain Based on Cardiac MR Tissue Tracking

Standard and emerging CMR methods for mitral regurgitation quantification

Cardiac magnetic resonance systematically overestimates mitral regurgitations by the indirect method

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