Standard and emerging CMR methods for mitral regurgitation quantification

Fidock, Benjamin, Archer, Gareth, Barker, Natasha, Elhawaz, Alaa, Al-Mohammad, Abdallah, Rothman, Alexander, Hose, Rod, Hall, Ian R., Grech, Ever, Briffa, Norman, Lewis, Nigel, van der Geest, Rob J., Zhang, Jun-Mei, Zhong, Liang, Swift, Andrew J., Wild, James M., De Gárate, Estefania, Bucciarelli-Ducci, Chiara, Bax, Jeroen J., Plein, Sven, Myerson, Saul and Garg, Pankaj (2021) Standard and emerging CMR methods for mitral regurgitation quantification. International Journal of Cardiology, 331. pp. 316-321. ISSN 1874-1754

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Abstract

Background: There are several methods to quantify mitral regurgitation (MR) by cardiovascular magnetic resonance (CMR). The interoperability of these methods and their reproducibility remains undetermined. Objective: To determine the agreement and reproducibility of different MR quantification methods by CMR across all aetiologies. Methods: Thirty-five patients with MR were recruited (primary MR = 12, secondary MR = 10 and MVR = 13). Patients underwent CMR, including cines and four-dimensional flow (4D flow). Four methods were evaluated: MR Standard (left ventricular stroke volume - aortic forward flow by phase contrast), MR LVRV (left ventricular stroke volume - right ventricular stroke volume), MR Jet (direct jet quantification by 4D flow) and MR MVAV (mitral forward flow by 4D flow - aortic forward flow by 4D flow). For all cases and MR types, 520 MR volumes were recorded by these 4 methods for intra−/inter-observer tests. Results: In primary MR, MR MVAV and MR LVRV were comparable to MR Standard (P > 0.05). MR Jet resulted in significantly higher MR volumes when compared to MR Standard (P < 0.05) In secondary MR and MVR cases, all methods were comparable. In intra-observer tests, MR MVAV demonstrated least bias with best limits of agreement (bias = −0.1 ml, −8 ml to 7.8 ml, P = 0.9) and best concordance correlation coefficient (CCC = 0.96, P < 0.01). In inter-observer tests, for primary MR and MVR, least bias and highest CCC were observed for MR MVAV. For secondary MR, bias was lowest for MR Jet (−0.1 ml, P[dbnd]NS). Conclusion: CMR methods of MR quantification demonstrate agreement in secondary MR and MVR. In primary MR, this was not observed. Across all types of MR, MR MVAV quantification demonstrated the highest reproducibility and consistency.

Item Type: Article
Additional Information: Funding Information: This work was supported by European Union funding (H2020 PHC-30?2015, 689617). AR was supported by the Wellcome Trust (206632/Z/17/Z). AS was supported by the Wellcome Trust (205188/Z/16/Z). PG was supported by the Academy of Medical Sciences (SGL018\1100) and the Wellcome Trust (215799/Z/19/Z, 220703/Z/20/Z).At Leeds, we thank the cardiac MR department for their assistance in recruiting and scanning patients. We thank the staff of the MRI unit at the University of Sheffield in facilitating CMR scans. Publisher Copyright: © 2021 The Authors
Uncontrolled Keywords: magnetic resonance imaging,mitral valve insufficiency,reproducibility of results,cardiology and cardiovascular medicine ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 17 Nov 2021 04:50
Last Modified: 24 Nov 2021 03:13
URI: https://ueaeprints.uea.ac.uk/id/eprint/82124
DOI: 10.1016/j.ijcard.2021.01.066

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