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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
- 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.
- Subjects :
- Male
Cardiac & Cardiovascular Systems
Time Factors
medicine.medical_treatment
LEFT-VENTRICULAR PERFORMANCE
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Severity of Illness Index
030218 nuclear medicine & medical imaging
VALVE-REPLACEMENT
0302 clinical medicine
Valve replacement
Mitral valve
magnetic resonance imaging
Stage (cooking)
Aged, 80 and over
medicine.diagnostic_test
Mitral Valve Insufficiency
ASSOCIATION
Middle Aged
medicine.anatomical_structure
1117 Public Health And Health Services
England
Echocardiography
Area Under Curve
Disease Progression
cardiovascular system
Cardiology
Mitral Valve
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Life Sciences & Biomedicine
medicine.medical_specialty
Left ventricular dilation
ISOVELOCITY SURFACE-AREA
Magnetic Resonance Imaging, Cine
Regurgitation (circulation)
1102 Cardiovascular Medicine And Haematology
Asymptomatic
Disease-Free Survival
SURGICAL-CORRECTION
VALVULAR REGURGITATION
03 medical and health sciences
Predictive Value of Tests
Physiology (medical)
Internal medicine
medicine
AORTIC REGURGITATION
Humans
cardiovascular diseases
Cardiac Surgical Procedures
Aged
outcome assessment (health care)
Mitral regurgitation
Science & Technology
business.industry
Patient Selection
1103 Clinical Sciences
Magnetic resonance imaging
SEVERITY
Peripheral Vascular Disease
Cardiovascular System & Hematology
ROC Curve
Cardiovascular System & Cardiology
Commentary
prognosis
business
TASK-FORCE
New Zealand
Subjects
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