Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging
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Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging. / Aplin, Mark; Kyhl, Kasper; Bjerre, Jenny; Ihlemann, Nikolaj; Greenwood, John P; Plein, Sven; Uddin, Akhlaque; Tønder, Niels; Høst, Nis Baun; Ahlström, Malin Glindvad; Hove, Jens; Hassager, Christian; Iversen, Kasper; Vejlstrup, Niels G.; Madsen, Per Lav.
In: European Heart Journal Cardiovascular Imaging, Vol. 17, No. 8, 2016, p. 863-870.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging
AU - Aplin, Mark
AU - Kyhl, Kasper
AU - Bjerre, Jenny
AU - Ihlemann, Nikolaj
AU - Greenwood, John P
AU - Plein, Sven
AU - Uddin, Akhlaque
AU - Tønder, Niels
AU - Høst, Nis Baun
AU - Ahlström, Malin Glindvad
AU - Hove, Jens
AU - Hassager, Christian
AU - Iversen, Kasper
AU - Vejlstrup, Niels G.
AU - Madsen, Per Lav
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.
PY - 2016
Y1 - 2016
N2 - AIMS: Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flow and cardiac chamber volume quantification. We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MIVol) related to severe MI.METHODS AND RESULTS: In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Aoflow). With increasing MI severity, MIVol, left heart volumes, and pulmonary venous diameters increased (P < 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MIVol >40 mL, MI regurgitant fraction >0.30, LV end-diastolic volume (LVEDV(i)) >108 mL m(-2), and a total left heart volume >188 mL m(-2) with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio >1.2. In severe MI, LV ejection fraction was unaffected, but the Aoflow and the peak ejection rate indexed to LVEDV were lowered (P < 0.05). In surgical patients, the MIVol correlated to the decrease in LV dimension after valve surgery (P < 0.02).CONCLUSION: CMR provides a reproducible quantitative technique for evaluation of MI, as MIVol and cardiac chamber volumes can be held against diagnostic cut-off values. The Aoflow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.
AB - AIMS: Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flow and cardiac chamber volume quantification. We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MIVol) related to severe MI.METHODS AND RESULTS: In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Aoflow). With increasing MI severity, MIVol, left heart volumes, and pulmonary venous diameters increased (P < 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MIVol >40 mL, MI regurgitant fraction >0.30, LV end-diastolic volume (LVEDV(i)) >108 mL m(-2), and a total left heart volume >188 mL m(-2) with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio >1.2. In severe MI, LV ejection fraction was unaffected, but the Aoflow and the peak ejection rate indexed to LVEDV were lowered (P < 0.05). In surgical patients, the MIVol correlated to the decrease in LV dimension after valve surgery (P < 0.02).CONCLUSION: CMR provides a reproducible quantitative technique for evaluation of MI, as MIVol and cardiac chamber volumes can be held against diagnostic cut-off values. The Aoflow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.
U2 - 10.1093/ehjci/jev321
DO - 10.1093/ehjci/jev321
M3 - Journal article
C2 - 26758406
VL - 17
SP - 863
EP - 870
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
SN - 2047-2404
IS - 8
ER -
ID: 164571602