Left Ventricular Assessment in Patients with Significant Mitral Incompetence; a Multi-Modality Imaging Study

Abstract

<i>Background:</i> Mitral valve regurgitation (MR) is a major cause of morbidity and death across the world. It obliges volume overload over left ventricle (LV) leading to LV dysfunction and subsequently heart failure. Detection of deleterious effect on left ventricle is crucial in guiding surgical decision in such cases.<i> Aim of the study:</i> Comprehensive assessment of left ventricle in case of significant primary mitral incompetence using multimodality imaging tools, namely 2D echo, 3D echo and cardiac magnetic resonance (CMR).<i> Methods:</i> 40 consecutive patients have been recruited from May 2019 to May 2021 in a prospective observational study which has been conducted in Aswan and Tanta heart centers. All patients suffered from significant primary MR. Patients underwent 2D echo where LV volumes, function and global longitudinal strain (GLS) were calculated. The same parameters were calculated by 3D echo. CMR study for all patient was done and post processing was done on appropriate software. LV volumes, function and GLS (feature tracking) were calculated in addition to detection of myocardial fibrosis.<i> Results: </i>End diastolic volume (EDV) and end systolic volume (ESV) were significantly larger when measured by CMR (mean EDV = 220.63, mean ESV = 87.6) as compared to 3D echo (mean EDV =180.43, mean ESV =68.13) and 2D echo (mean EDV =166.25, mean ESV=61.58) (all P <0.001). EDV measures were strongly correlated with CMR and 3D echocardiography (r=0.88, p < 0.001).2D echo ESV measures were strongly correlated with CMR and 3D echo (r=0.7 and 0.63 respectively, P<0.001).3D echo ESV measures were moderately correlated with CMR (r=0.5, P<0.001). GLS values measured by 2D and CMR were moderately correlated (r=0.5, p<0.001).<i> Conclusion:</i> Left ventricle is playing an important role in the prognosis and intervention decision in mitral regurgitation. It’s important to identify early deleterious LV changes so that intervention is recommended prior to the development of irreversible LV damage.