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Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantification

Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantification

Authors :
Jane M. Francis
Jonathan P. Christiansen
Laura E Dobson
Stefan Neubauer
John P Greenwood
Joanna d’Arcy
Bernard D. Prendergast
Saul G. Myerson
Raad H. Mohiaddin
Theodoros D. Karamitsos
Source :
Circulation. 133:2287-2296
Publication Year :
2016
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2016.

Abstract

Background— Surgery for severe mitral regurgitation is indicated if symptoms or left ventricular dilation or dysfunction occur. However, prognosis is already reduced by this stage, and earlier surgery on asymptomatic patients has been advocated if valve repair is likely, but identifying suitable patients for early surgery is difficult. Quantifying the regurgitation may help, but evidence for its link with outcome is limited. Cardiovascular magnetic resonance (CMR) can accurately quantify mitral regurgitation, and we examined whether this was associated with the future need for surgery. Methods and Results— One hundred nine asymptomatic patients with echocardiographic moderate or severe mitral regurgitation had baseline CMR scans and were followed up for up to 8 years (mean, 2.5±1.9 years). CMR quantification accurately identified patients who progressed to symptoms or other indications for surgery: 91% of subjects with regurgitant volume ≤55 mL survived to 5 years without surgery compared with only 21% with regurgitant volume >55 mL ( P 40%. CMR-derived end-diastolic volume index showed a weaker association with outcome (proportions surviving without surgery at 5 years, 90% for left ventricular end-diastolic volume index 2 versus 48% for ≥100 mL/m 2 ) and added little to the discriminatory power of regurgitant fraction/volume alone. Conclusions— CMR quantification of mitral regurgitation was associated with the development of symptoms or other indications for surgery and showed better discriminatory ability than the reference-standard CMR-derived ventricular volumes. CMR may be able to identify appropriate patients for early surgery, with the potential to change clinical practice, although the clinical benefits of early surgery require confirmation in a clinical trial.

Details

ISSN :
15244539 and 00097322
Volume :
133
Database :
OpenAIRE
Journal :
Circulation
Accession number :
edsair.doi.dedup.....720b1fb11fd06d924fe72ed491ab16da
Full Text :
https://doi.org/10.1161/circulationaha.115.017888