The importance of mitral valve prolapse doming volume in the assessment of left ventricular stroke volume with cardiac MRI

Li, Rui, Assadi, Hosamadin ORCID:, Matthews, Gareth ORCID:, Mehmood, Zia, Grafton-Clarke, Ciaran ORCID:, Kasmai, Bahman, Hewson, David, Greenwood, Richard, Spohr, Hilmar, Zhong, Liang, Zhao, Xiaodan, Sawh, Chris, Duehmke, Rudolf, Vassiliou, Vassilios S. ORCID:, Nelthorpe, Faye, Ashman, David, Curtin, John, Yashoda, Gurung-Koney, van der Geest, Rob J., Alabed, Samer, Swift, Andrew J., Hughes, Marina and Garg, Pankaj ORCID: (2023) The importance of mitral valve prolapse doming volume in the assessment of left ventricular stroke volume with cardiac MRI. Medical Sciences, 11 (1). ISSN 2076-3271

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There remains a debate whether the ventricular volume within prolapsing mitral valve (MV) leaflets should be included in the left ventricular (LV) end-systolic volume, and therefore factored in LV stroke volume (SV), in cardiac magnetic resonance (CMR) assessments. This study aims to compare LV volumes during end-systolic phases, with and without the inclusion of the volume of blood on the left atrial aspect of the atrioventricular groove but still within the MV prolapsing leaflets, against the reference LV SV by four-dimensional flow (4DF). A total of 15 patients with MV prolapse (MVP) were retrospectively enrolled in this study. We compared LV SV with (LV SVMVP) and without (LV SVstandard) MVP left ventricular doming volume, using 4D flow (LV SV4DF) as the reference value. Significant differences were observed when comparing LV SVstandard and LV SVMVP (p < 0.001), and between LV SVstandard and LV SV4DF (p = 0.02). The Intraclass Correlation Coefficient (ICC) test demonstrated good repeatability between LV SVMVP and LV SV4DF (ICC = 0.86, p < 0.001) but only moderate repeatability between LV SVstandard and LV SV4DF (ICC = 0.75, p < 0.01). Calculating LV SV by including the MVP left ventricular doming volume has a higher consistency with LV SV derived from the 4DF assessment. In conclusion, LV SV short-axis cine assessment incorporating MVP dooming volume can significantly improve the precision of LV SV assessment compared to the reference 4DF method. Hence, in cases with bi-leaflet MVP, we recommend factoring in MVP dooming into the left ventricular end-systolic volume to improve the accuracy and precision of quantifying mitral regurgitation.

Item Type: Article
Additional Information: Funding: PG is funded by Wellcome Trust Clinical Research Career Development Fellowships (220703/Z/20/Z). For the purpose of Open Access, this author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, data collection and analysis, publication decision, or manuscript preparation. Data Availability Statement: Underlying data: access to the raw images of patients is not permitted since specialised post-processing imaging-based solutions can identify the study patients in the future.
Uncontrolled Keywords: ai,flow quantification,mitral valve prolapse,reliability,medicine(all) ,/dk/atira/pure/subjectarea/asjc/2700
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Social Sciences > School of Psychology
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
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Depositing User: LivePure Connector
Date Deposited: 25 Jan 2023 10:30
Last Modified: 19 May 2023 09:40
DOI: 10.3390/medsci11010013

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