Discordance Between Echocardiography and MRI in the Assessment of Mitral Regurgitation Severity

Abstract Background The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity e...

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Published in:Journal of the American College of Cardiology 2015-03, Vol.65 (11), p.1078-1088
Main Authors: Uretsky, Seth, MD, Gillam, Linda, MD, MPH, Lang, Roberto, MD, Chaudhry, Farooq A., MD, Argulian, Edgar, MD, MPH, Supariwala, Azhar, MD, Gurram, Srinivasa, MD, Jain, Kavya, MD, Subero, Marjorie, MD, Jang, James J., MD, Cohen, Randy, MD, Wolff, Steven D., MD, PhD
Format: Article
Language:English
Subjects:
Cardiology
Cardiovascular
Heart attacks
Integrated approach
Internal Medicine
Laboratories
mitral valve insufficiency
mitral valve surgery
NMR
Nuclear magnetic resonance
observer variation
quantification
Questioning
remodeling
reproducibility of results
Stroke
Studies
Surgery
Veins & arteries
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Summary:Abstract Background The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important. Objectives The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard. Methods In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume. Results Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p < 0.0001), and there was a poorer correlation in the subset of patients sent for surgery (r = 0.4; p = 0.01). There was a strong correlation between post-surgical LV remodeling and MR severity as assessed by MRI (r = 0.85; p 
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2014.12.047