Author + information
- Lauren A. Simprini,
- Anika Afroz,
- Igor Klem,
- Christoph Jensen,
- Raymond Kim,
- John Heitner,
- Michael Sood,
- Elizabeth Chandy,
- Dipan Shah,
- Juan Lopez-Mattei,
- Robert Biederman,
- Monvadi B. Srichai,
- John Grizzard,
- Anthony Fuisz,
- Kambiz Ghafourian,
- Afshin Farzaneh-Far and
- Jonathan Weinsaft
Mitral regurgitation (MR) is important for patients (pts) with prosthetic mitral valves (PMV). Routine cine CMR can assess MR based on regurgitation associated intervoxel dephasing. Diagnostic performance of cine CMR for prosthesis associated MR is unknown.
Databases at 9 sites were queried for PMV pts with both CMR and echocardiography. Cine CMR visually graded MR by jet size; signal intensity and pulmonary vein reversal (PVR) were also scored. TTE/TEE was used as a comparator for MR. Cine CMR was read blinded to pt history and TTE/TEE
67 pts (63±13 yo, 39% male) with PMV (63% mechanical, 37% bio) underwent cine CMR and echo (TTE 76%, TEE 46%) within 2.6±2.7 days. MR was seen on cine CMR in 73% of pts (mild 40%, moderate 8%, severe 25%) and varied in direction (central 86%, eccentric 14%). Pts with severe MR more commonly had dense regurgitant jets (73% vs 11%, p<0.001), PVR (55% vs 3%, p<0.001) and larger left atria (5.7±1.0cm vs 4.7±1.1cm, p<0.01) but did not differ by LVEF (53±14% vs 47±16%, p=0.3). Compared to TEE, cine CMR yielded high accuracy (97%) for severe MR; accuracy was also high (87%) when a broader threshold (moderate MR) was used (Table). Among pts with TTE and cine CMR, none had severe MR on TTE missed by cine CMR whereas TTE was discordant (lesser MR) in 83% (5/6) with severe MR on cine CMR.
Routine cine CMR yields excellent diagnostic performance for TEE evidenced severe MR in pts with PMV. Findings support use of cine CMR for noninvasive assessment of prosthesis associated MR.
|Sensitivity||Specificity||Accuracy||Positive Predictive Value||Negative Predictive Value|
|Severe MR||100% (6/6)||96% (24/25)||97% (30/31)||86% (6/7)||100% (24/24)|
|Substantial (≥moderate) MR||82% (9/11)||90% (18/20)||87% (27/31)||82% (9/11)||90% (18/20)|
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Imaging: MRI IV CMR in Valve Disease and Imaging Intracardiac and Vascular Flows
Abstract Category: 19. Imaging: MRI
Presentation Number: 1224-313
- 2013 American College of Cardiology Foundation