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Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study.
J Cardiovasc Magn Reson. 2017 Jul 27; 19(1):56.JC

Abstract

BACKGROUND

To quantify mitral regurgitation (MR) with CMR, the regurgitant volume can be calculated as the difference between the left ventricular (LV) stroke volume (SV) measured with the Simpson's method and the reference SV, i.e. the right ventricular SV (RVSV) in patients without tricuspid regurgitation. However, for patients with prominent mitral valve prolapse (MVP), the Simpson's method may underestimate the LV end-systolic volume (LVESV) as it only considers the volume located between the apex and the mitral annulus, and neglects the ventricular volume that is displaced into the left atrium but contained within the prolapsed mitral leaflets at end systole. This may lead to an underestimation of LVESV, and resulting an over-estimation of LVSV, and an over-estimation of mitral regurgitation. The aim of the present study was to assess the impact of prominent MVP on MR quantification by CMR.

METHODS

In patients with MVP (and no more than trace tricuspid regurgitation) MR was quantified by calculating the regurgitant volume as the difference between LVSV and RVSV. LVSVuncorr was calculated conventionally as LV end-diastolic (LVEDV) minus LVESV. A corrected LVESVcorr was calculated as the LVESV plus the prolapsed volume, i.e. the volume between the mitral annulus and the prolapsing mitral leaflets. The 2 methods were compared with respect to the MR grading. MR grades were defined as absent or trace, mild (5-29% regurgitant fraction (RF)), moderate (30-49% RF), or severe (≥50% RF).

RESULTS

In 35 patients (44.0 ± 23.0y, 14 males, 20 patients with MR) the prolapsed volume was 16.5 ± 8.7 ml. The 2 methods were concordant in only 12 (34%) patients, as the uncorrected method indicated a 1-grade higher MR severity in 23 (66%) patients. For the uncorrected/corrected method, the distribution of the MR grades as absent-trace (0 vs 11, respectively), mild (20 vs 18, respectively), moderate (11 vs 5, respectively), and severe (4 vs 1, respectively) was significantly different (p < 0.001). In the subgroup without MR, LVSVcorr was not significantly different from RVSV (difference: 2.5 ± 4.7 ml, p = 0.11 vs 0) while a systematic overestimation was observed with LVSVuncorr (difference: 16.9 ± 9.1 ml, p = 0.0007 vs 0). Also, RVSV was highly correlated with aortic forward flow (n = 24, R 2 = 0.97, p < 0.001).

CONCLUSION

For patients with severe bileaflet prolapse, the correction of the LVSV for the prolapse volume is suggested as it modified the assessment of MR severity by one grade in a large portion of patients.

Authors+Show Affiliations

Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland. Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland. Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland. Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland.Pediatric Cardiology unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland. Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland. Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.Center for Cardiac Magnetic Resonance (CRMC), University Hospital of Lausanne (CHUV), Lausanne, Switzerland. pierre.monney@chuv.ch. Service de Cardiologie, Département Cœur - Vaisseaux, University Hospital of Lausanne (CHUV), Lausanne, Switzerland. pierre.monney@chuv.ch.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28750632

Citation

Vincenti, Gabriella, et al. "Impact of Bileaflet Mitral Valve Prolapse On Quantification of Mitral Regurgitation With Cardiac Magnetic Resonance: a Single-center Study." Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, vol. 19, no. 1, 2017, p. 56.
Vincenti G, Masci PG, Rutz T, et al. Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study. J Cardiovasc Magn Reson. 2017;19(1):56.
Vincenti, G., Masci, P. G., Rutz, T., De Blois, J., Prša, M., Jeanrenaud, X., Schwitter, J., & Monney, P. (2017). Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study. Journal of Cardiovascular Magnetic Resonance : Official Journal of the Society for Cardiovascular Magnetic Resonance, 19(1), 56. https://doi.org/10.1186/s12968-017-0362-6
Vincenti G, et al. Impact of Bileaflet Mitral Valve Prolapse On Quantification of Mitral Regurgitation With Cardiac Magnetic Resonance: a Single-center Study. J Cardiovasc Magn Reson. 2017 Jul 27;19(1):56. PubMed PMID: 28750632.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study. AU - Vincenti,Gabriella, AU - Masci,Pier Giorgio, AU - Rutz,Tobias, AU - De Blois,Jonathan, AU - Prša,Milan, AU - Jeanrenaud,Xavier, AU - Schwitter,Juerg, AU - Monney,Pierre, Y1 - 2017/07/27/ PY - 2017/02/24/received PY - 2017/05/10/accepted PY - 2017/7/29/entrez PY - 2017/7/29/pubmed PY - 2018/5/2/medline KW - Barlow KW - Cardiac magnetic resonance KW - Mitral regurgitation KW - Mitral valve KW - Prolapse SP - 56 EP - 56 JF - Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance JO - J Cardiovasc Magn Reson VL - 19 IS - 1 N2 - BACKGROUND: To quantify mitral regurgitation (MR) with CMR, the regurgitant volume can be calculated as the difference between the left ventricular (LV) stroke volume (SV) measured with the Simpson's method and the reference SV, i.e. the right ventricular SV (RVSV) in patients without tricuspid regurgitation. However, for patients with prominent mitral valve prolapse (MVP), the Simpson's method may underestimate the LV end-systolic volume (LVESV) as it only considers the volume located between the apex and the mitral annulus, and neglects the ventricular volume that is displaced into the left atrium but contained within the prolapsed mitral leaflets at end systole. This may lead to an underestimation of LVESV, and resulting an over-estimation of LVSV, and an over-estimation of mitral regurgitation. The aim of the present study was to assess the impact of prominent MVP on MR quantification by CMR. METHODS: In patients with MVP (and no more than trace tricuspid regurgitation) MR was quantified by calculating the regurgitant volume as the difference between LVSV and RVSV. LVSVuncorr was calculated conventionally as LV end-diastolic (LVEDV) minus LVESV. A corrected LVESVcorr was calculated as the LVESV plus the prolapsed volume, i.e. the volume between the mitral annulus and the prolapsing mitral leaflets. The 2 methods were compared with respect to the MR grading. MR grades were defined as absent or trace, mild (5-29% regurgitant fraction (RF)), moderate (30-49% RF), or severe (≥50% RF). RESULTS: In 35 patients (44.0 ± 23.0y, 14 males, 20 patients with MR) the prolapsed volume was 16.5 ± 8.7 ml. The 2 methods were concordant in only 12 (34%) patients, as the uncorrected method indicated a 1-grade higher MR severity in 23 (66%) patients. For the uncorrected/corrected method, the distribution of the MR grades as absent-trace (0 vs 11, respectively), mild (20 vs 18, respectively), moderate (11 vs 5, respectively), and severe (4 vs 1, respectively) was significantly different (p < 0.001). In the subgroup without MR, LVSVcorr was not significantly different from RVSV (difference: 2.5 ± 4.7 ml, p = 0.11 vs 0) while a systematic overestimation was observed with LVSVuncorr (difference: 16.9 ± 9.1 ml, p = 0.0007 vs 0). Also, RVSV was highly correlated with aortic forward flow (n = 24, R 2 = 0.97, p < 0.001). CONCLUSION: For patients with severe bileaflet prolapse, the correction of the LVSV for the prolapse volume is suggested as it modified the assessment of MR severity by one grade in a large portion of patients. SN - 1532-429X UR - https://www.unboundmedicine.com/medline/citation/28750632/Impact_of_bileaflet_mitral_valve_prolapse_on_quantification_of_mitral_regurgitation_with_cardiac_magnetic_resonance:_a_single_center_study_ L2 - https://jcmr-online.biomedcentral.com/articles/10.1186/s12968-017-0362-6 DB - PRIME DP - Unbound Medicine ER -