Abstract
Background Indirect quantification of mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR), currently used as a second-line diagnostic tool after echocardiography, can be achieved by three methods. Each method has its advantages and disadvantages due to the limitations of the underlying techniques used to determine ventricular volumes and/or flow information. The aim of the study was to compare all three indirect CMR methods to determine their agreement in grading MR severity. Methods This prospective study comprised 29 patients (mean age 60 ± 11 (standard deviation (SD)), 97% males) with severe chronic MR who underwent an echocardiographic and CMR exam prior to surgery. Steady-state free precession sequences were used to obtain a short-axis data set to evaluate left and right ventricular stroke volumes (LV/ RVSV) and phase-contrast velocity sequences were applied to obtain aortic forward flow (AoFF) and mitral inflow (MiIF). The mitral regurgitant volume (MRV) was determined by the ‘standard’ (MRV = LVSV - AoFF), ‘volumetric’ (can only be used in the absence of multivalvular disease and intra-cardiac shunt; MRV = LVSV RVSV) and ‘flow’ method (MRV = MiIF - AoFF). The mitral regurgitant fraction (MRF) was calculated as follows: MRV/LVSV x 100% (‘standard’/‘volumetric’ method) or MRV/MiIF x 100% (‘flow’ method). Agreement between the techniques was evaluated using the Bland-Altman method.
Highlights
Indirect quantification of mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR), currently used as a second-line diagnostic tool after echocardiography, can be achieved by three methods
Seven patients had ≥ mild pulmonary and/or tricuspid regurgitation according to echocardiography and were excluded from the ‘volumetric’ method
There was good to moderate agreement between the methods despite wide 95% limits of agreement
Summary
Indirect quantification of mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR), currently used as a second-line diagnostic tool after echocardiography, can be achieved by three methods. Each method has its advantages and disadvantages due to the limitations of the underlying techniques used to determine ventricular volumes and/or flow information. The aim of the study was to compare all three indirect CMR methods to determine their agreement in grading MR severity
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