Valvular Cardiomyopathy: The Value of Cardiovascular Magnetic Resonance Imaging

Abstract

Cardiovascular magnetic resonance (CMR) imaging has had a vast impact on the understanding of a wide range of disease processes and pathophysiological mechanisms. More recently, it has contributed significantly to the diagnosis and risk stratification of patients with valvular heart disease. With its increasing use, CMR allows for a detailed, reproducible, qualitative, and quantitative evaluation of left ventricular volumes and mass, thereby enabling assessment of the haemodynamic impact of a valvular lesion upon the myocardium. Postprocessing of the routinely acquired images with feature tracking CMR methodology can give invaluable information about myocardial deformation and strain parameters that suggest subclinical ventricular impairment that remains undetected by conventional measures such as the ejection fraction (EF). T1 mapping and late gadolinium enhancement (LGE) imaging provide deep myocardial tissue characterisation that is changing the approach towards risk stratification of patients as an increasing body of evidence suggests that the presence of fibrosis is related to adverse events and prognosis. This review summarises the current evidence regarding the utility of CMR in the left ventricular assessment of patients with aortic stenosis or mitral regurgitation and its value in diagnosis, risk stratification, and management.

Phosphorus Magnetic Resonance Spectroscopy (31P MRS) and Cardiovascular Disease: The Importance of Energy

“…Both aortic and mitral valve disease have been shown to have a significant impact on the myocardium [ 91 ]. This is depicted in the cardiac metabolic profile of these patients as well.…”

Is there a role for biomarkers in asymptomatic severe chronic primary mitral regurgitation?

“…CMR offers many advantages in the patient with chronic primary MR. CMR assesses volumetric flows and hence for more accurate, and reproducible measurements of MR severity, particularly when faced with eccentric MR which is often difficult to quantify with conventional echocardiography. Furthermore, CMR is considered the gold standard for the assessments of LV dimensions and LV function and can also provide accurate quantification of LA size and volume [43][44][45][46][47][48][49]. While there is a paucity of high-quality data on CMR based risk-stratification in patients with stage C1 disease, the ACC/AHA Guidelines, provides a Class 1 recommendation for CMR to assess LV and RV volumes and function and MR severity when there is a discrepancy between clinical assessments and echocardiography.…”