Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center studyReport as inadecuate

Impact of bileaflet mitral valve prolapse on quantification of mitral regurgitation with cardiac magnetic resonance: a single-center study - Download this document for free, or read online. Document in PDF available to download.

Journal of Cardiovascular Magnetic Resonance

, 19:56

First Online: 27 July 2017Received: 24 February 2017Accepted: 10 May 2017


BackgroundTo 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.

MethodsIn 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.

ResultsIn 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 = 0.97, p < 0.001.

ConclusionFor 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.

KeywordsMitral regurgitation Mitral valve Prolapse Barlow Cardiac magnetic resonance AbbreviationsAOforwardAortic forward flow

CMRCardiac magnetic resonance

FOVField of view

LALeft atrium

LVLeft ventricle

LVEDVLeft ventricular end-diastolic volume

LVESVLeft ventricular end-systolic volume

LVESVcorrLeft ventricular end-systolic volume corrected for prolapsed volume

LVESVuncorrLeft ventricular end-systolic volume Simpson’s method

LVSVLeft ventricular stroke volume

MRMitral regurgitation

MVPMitral valve prolapse

PISAProximal isovelocity surface area

RegvolRegurgitant volume

RFRegurgitant fraction

RVSVRight ventricular stroke volume

SVStroke volume

TEEcho time

TRRepetition time

VENCVelocity encoding

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Author: Gabriella Vincenti - Pier Giorgio Masci - Tobias Rutz - Jonathan De Blois - Milan Prša - Xavier Jeanrenaud - Juerg Schwit


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