Abstract
BackgroundDetecting and quantifying the severity of mitral regurgitation is essential for risk stratification and clinical decision-making regarding timing of surgery. Our objective was to assess specific visual parameters by cine-magnetic resonance imaging (MRI) in the determination of the severity of mitral regurgitation and to compare it to previously validated imaging modalities: echocardiography and cardiac ventriculography.MethodsThe study population consisted of 68 patients who underwent a cardiac MRI followed by an echocardiogram within a median time of 2.0 days and 49 of these patients who had a cardiac catheterization, median time of 2.0 days. The inter-rater agreement statistic (Kappa) was used to evaluate the agreement.ResultsThere was moderate agreement between cine MRI and Doppler echocardiography in assessing mitral regurgitation severity, with a kappa value of 0.47, confidence interval (CI) 0.29–0.65. There was also fair agreement between cine MRI and cardiac catheterization with a kappa value of 0.36, CI of 0.17–0.55.ConclusionCine MRI offers a reasonable alternative to both Doppler echocardiography and, to a lesser extent, cardiac catheterization for visually assessing the severity of mitral regurgitation with specific visual parameters during routine clinical cardiac MRI.
Highlights
Long-term outcomes of patients with mitral regurgitation have demonstrated increasing rates of heart failure, atrial fibrillation and sudden cardiac death. [1,2] The mortality risk has been shown to be directly related to the severity of mitral regurgitation. [3] In addition, the severity of mitral regurgitation is a major determinant that leads to left ventricular dilatation and dysfunction. [4] detecting and quantifying the severity of mitral regurgitation is essential for risk stratification and clinical decision-making regarding timing of surgery
Cine magnetic resonance imaging (MRI) Compared to Doppler Echocardiography There was moderate agreement between cine MRI and Doppler echocardiography in assessing mitral regurgitation severity, with a kappa value of 0.47, confidence interval (CI) 0.29–0.65 (Table 4)
Of the 29 patients diagnosed with mild or no mitral regurgitation by cine MRI, 28 of them had the same findings by echocardiography
Summary
Long-term outcomes of patients with mitral regurgitation have demonstrated increasing rates of heart failure, atrial fibrillation and sudden cardiac death. [1,2] The mortality risk has been shown to be directly related to the severity of mitral regurgitation. [3] In addition, the severity of mitral regurgitation is a major determinant that leads to left ventricular dilatation and dysfunction. [4] detecting and quantifying the severity of mitral regurgitation is essential for risk stratification and clinical decision-making regarding timing of surgery. Echocardiography and cardiac ventriculography are well-validated techniques in assessing the severity of mitral regurgitation. [5,6] Magnetic resonance imaging (MRI) has been shown to be able to assess mitral regurgitation, it lacks the validation that exists with echocardiography and cardiac ventriculography. Flow velocity mapping and volumetric assessment have been validated in prior studies comparing it to other imaging modalities, they require different pulse sequences and/or extra time in post processing. [8] there have been no studies to date that have validated assessment of the severity of mitral regurgitation using the newer cine pulse sequence SSFP (Steady-state free precession). Our objective was to assess specific visual parameters by cine-magnetic resonance imaging (MRI) in the determination of the severity of mitral regurgitation and to compare it to previously validated imaging modalities: echocardiography and cardiac ventriculography
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