Abstract
Both Transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) have well-established role in mitral regurgitation (MR) quantification for optimal management strategy. We assessed the correlation between TTE and CMR in the quantification of MR. Participants with isolated MR and echocardiographic mitral regurgitant volume (RVol) ≥ 30 mL/beat were included. A consecutive sample of 30 participants (Mean age 52.7 ± 19.3 years, 50% males) was selected and referred for indirect and direct CMR quantification of mitral RVol. There was a statistically significant strong positive correlation between the echocardiographic and indirect CMR quantification of the mitral RVol (r = 0.753, P < 0.001) and a statistically significant moderate positive correlation between the echocardiographic and direct CMR quantification of the mitral RVol (r = 0.530, P < 0.003). The inter-observer reliability of the MR grade between TTE and CMR showed a statistically significant moderate agreement (κ = 0.502, P = 0.0001) when the observers used the echocardiographic mitral RVol for grading of MR. On the other hand, the inter-observer reliability of the MR grade between TTE and CMR showed a statistically significant faint agreement (κ = 0.251, P = 0.024) when the observers used the echocardiographic regurgitant fraction (RF) for grading of MR. The positive reciprocal relationship between the CMR and the TTE highlights the potential role of the CMR as a concomitant imaging tool for quantification of the mitral RVol and grading of isolated MR, especially with limited or inconclusive TTE studies. This will enhance the management strategy and improve outcomes.
Highlights
Mitral regurgitation (MR) is a major cause of morbidity and mortality affecting 38,270 persons per 1 million US adult population [1]
There was a statistically significant strong positive correlation between Echo_RVol and CMR_RVol1 (r = 0.753, n = 30, P < 0.001) (Fig. 2) and a statistically significant good reliability between Echo_RVol and CMR_RVol1 (ICC = 0.859, 95% CI 0.706-0.932, P ≤ 0.0001) (Table 5), a statistically significant moderate positive correlation between Echo_RVol and CMR_RVol2 (r = 0.530, n = 30, P < 0.003) (Fig. 3), and statistically significant moderate reliability between Echo_RVol and CMR_RVol2 (ICC 0.557, P ≤ 0.001)
Our study showed that CMR_RVol2 had a moderate correlation with Echo_RVol (ICC 0.557, P < 0.001)
Summary
Mitral regurgitation (MR) is a major cause of morbidity and mortality affecting 38,270 persons per 1 million US adult population [1]. Subgroup analysis of the European registry of MR (EuMiClip) data showed a 5.2% prevalence of significant MR and 70% of patients with severe primary MR had a class I indication for surgery [2]. Transthoracic echocardiography (TTE) is the standard approach for the assessment of MR. Despite its numerous technical and non-technical limitations, TTE has been recommended by the American Society of Echocardiography for the quantification of MR [3]. Cardiac magnetic resonance (CMR) is a favored diagnostic imaging technique for valvular heart disease due to its numerous features as non-ionizing radiation, excellent imaging quality, unlimited scan widows with high accuracy and reproducibility, and tissue diagnosis [4]. We wanted to evaluate the correlation between TTE and CMR in the quantification of MR and explore their complementary use for enhancing diagnostic accuracy and improving patient outcomes
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