Lauren A. Simprini1, Anika Afroz2, Mitchell A. Cooper2, Igor Klem3, Christoph Jensen3, Raymond J. Kim3, Monvadi B. Srichai4, John F. Heitner5, Michael Sood5, Elizabeth Chandy5, Dipan J. Shah6, Juan Lopez-Mattei6, Robert W. Biederman7, John D. Grizzard8, Anthon Fuisz9, Kambiz Ghafourian9, Afshin Farzaneh-Far10, Jonathan Weinsaft1,2
1Memorial Sloan Kettering Cancer Center, New York, NY, 2Weill Cornell Medical College, New York, NY, 3Duke Cardiovascular Magnetic Resonance Center, Durham, NC, 4New York University Langone Medical Center, New York, NY, 5New York Methodist Hospital, Brooklyn, New York, NY, 6Methodist DeBakey Heart and Vascular Center, Houston, Texas, 7Allegheny General Hospital, Pittsburgh, PA, 8Virginia Commonwealth University, Richmond, VA, 9Washington Hospital Center, Washington, DC, 10University of Illinois/Chicago, Chicago, IL, USA
Background and aim of the study: Mitral regurgitation (MR) is an important complication after prosthetic mitral valve (PMV) implantation. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with PMV. Cine-cardiac magnetic resonance (CMR) holds the potential for the non-invasive assessment of regurgitant severity based on MR-induced inter-voxel dephasing. The study aim was to evaluate routine cine-CMR for the visual assessment of PMV-associated MR.
Methods: Routine cine-CMR was performed at nine sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild <1/3, moderate 1/3-2/3, severe >2/3). MR was graded in each long-axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PVSFR). Visual interpretation was compared to quantitative analysis in a single-center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort.
Results: The population comprised 85 PMV patients (59% mechanical valves, 41% bioprostheses). Among the
derivation cohort (n = 25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p = 0.001). Patients with severe MR had an almost three-fold increase in quantitative jet area (p = 0.002), and a two-fold increase in density (p = 0.04) than did other patients. Among the multicenter cohort, cine-CMR and TEE (Δ = 2 ± 3 days) demonstrated moderate agreement (κ = 0.44); 64% of discordances differed by ≤1 grade (Δ = 1.2 ± 0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value = 100%). Patients with visually graded severe MR also had more frequent PVSFR (p <0.001), denser jets (p <0.001), and larger left atria (p = 0.01) on cine-CMR.
Conclusion: Cine-CMR is useful for the assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR assessment based on jet size provides an accurate non-invasive means of screening for TEE-evidenced severe MR.
The Journal of Heart Valve Disease 2014;23:575-582
|Routine Cine-CMR for Prosthesis-Associated Mitral Regurgitation: A Multicenter Comparison to Echocardiography|
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