Mark Aplin1, Kasper Kyhl1, Jenny Bjerre1, Nikolaj Ihlemann1, John P Greenwood2, Sven Plein2, Akhlaque Uddin2, Niels Tønder3, Nis Baun Høst4, Malin Glindvad Ahlström1, Jens Hove5, Christian Hassager1, Kasper Iversen6, Niels G Vejlstrup1, Per Lav Madsen7. 1. Department of Cardiology, Copenhagen University Hospitals of Rigshospitalet, Copenhagen, Denmark. 2. Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds University, Leed, UK. 3. Department of Cardiology, Copenhagen University Hospitals of Hillerød, Copenhagen, Denmark. 4. Department of Cardiology, Copenhagen University Hospitals of Bispebjerg, Copenhagen, Denmark. 5. Department of Cardiology, Copenhagen University Hospitals of Hvidovre, Copenhagen, Denmark. 6. Department of Cardiology, Copenhagen University Hospitals of Herlev, Herlev Ringvej 75, Copenhagen, Denmark. 7. Department of Cardiology, Copenhagen University Hospitals of Herlev, Herlev Ringvej 75, Copenhagen, Denmark lav.madsen@gmail.com.
Abstract
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. Published on behalf of the European Society of Cardiology. All rights reserved.
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. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Rine Bakkestrøm; Ann Banke; Redi Pecini; Akhmadjon Irmukhamedov; Søren Kristian Nielsen; Mads J Andersen; Barry A Borlaug; Jacob Eifer Moller Journal: Open Heart Date: 2018-12-16