Mitral regurgitation (MR) is an important complication after prosthetic mitral valve (PMV) implantation. Transthoracic echocardiography is widely used to screen for native MR, but can be limited with ...PMV. Cine-cardiac magnetic resonance (CMR) holds the potential for the non-invasive assessment of regurgitant severity based on MR-induced inter-voxel dephasing. The study aim was to evaluate routine cine-CMR for the visual assessment of PMV-associated MR.
Routine cine-CMR was performed at nine sites. A uniform protocol was used to grade MR based on jet size in relation to the left atrium (mild < 1/3, moderate 1/3-2/3, severe > 2/3). MR was graded in each long-axis orientation, with overall severity based on cumulative grade. Cine-CMR was also scored for MR density and pulmonary vein systolic flow reversal (PVSFR). Visual interpretation was compared to quantitative analysis in a single-center (derivation) cohort, and to transesophageal echocardiography (TEE) in a multicenter (validation) cohort.
The population comprised 85 PMV patients (59% mechanical valves, 41% bioprostheses). Among the derivation cohort (n = 25), quantitative indices paralleled visual scores, with stepwise increases in jet size and density in relation to visually graded MR severity (both p = 0.001). Patients with severe MR had an almost three-fold increase in quantitative jet area (p = 0.002), and a two-fold increase in density (p = 0.04) than did other patients. Among the multicenter cohort, cine-CMR and TEE (Δ =. 2 ± 3 days) demonstrated moderate agreement (κ = 0.44); 64% of discordances differed by ≤ 1 grade (Δ = 1.2 ± 0.5). Using a TEE reference, cine-CMR yielded excellent diagnostic performance for severe MR (sensitivity, negative predictive value = 100%). Patients with visually graded severe MR also had more frequent PVSFR (p < 0.001), denser jets (p < 0.001), and larger left atria (p = 0.01) on cine-CMR.
Cine-CMR is useful for the assessment of PMV-associated MR, which manifests concordant quantitative and qualitative changes in size and density of inter-voxel dephasing. Visual MR assessment based on jet size provides an accurate non-invasive means of screening for TEE-evidenced severe MR.
Noninvasive functional imaging of the heart using MRI: opportunities and challenges Yi Wang; Nguyen, T.D.; Spincemaille, P. ...
2007 Joint Meeting of the 6th International Symposium on Noninvasive Functional Source Imaging of the Brain and Heart and the International Conference on Functional Biomedical Imaging,
2007-Oct.
Conference Proceeding
Magnetic resonance imaging (MRI) provides high spatial resolution, temporal resolution, and tissue contrast. It is ideally suited for the noninvasive assessment of cardiac structure and function. For ...routine cardiac patient management, functional assessment includes ventricular and valvular function, myocardial viability, perfusion, and metabolism. Highly desired but not yet available for managing myocardial infarction is the noninvasive assessment of coronary plaque vulnerability. MRI offers great potential in the functional evaluation of both ischemic and nonischemic cardiomyopathies. For these important roles in cardiac imaging, the current status of MRI technology is reviewed and its future developments are discussed.
Two patients with prosthetic aortic valves--one bioprosthetic and one mechanical--presented with bacteremia and underwent evaluation for infective prosthetic valve endocarditis. Multidetector ...computed tomography (MDCT) imaging demonstrated vegetations on both prosthetic valves confirmed by transesophageal echocardiography. Based on the MDCT coronary artery assessment, neither patient underwent pre-operative invasive coronary angiography. Both patients underwent surgical treatment without complication. In conclusion, this report demonstrates that MDCT can, in some cases, accurately image vegetations on prosthetic aortic valves in infective endocarditis.
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