Skip to main content
SpringerLink
Log in

Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Primary Mitral Regurgitation

  • Cardiac PET, CT, and MRI (P Cremer, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review offers an evidence-based analysis of established and emerging cardiovascular magnetic resonance (CMR) techniques used to assess the severity of primary mitral regurgitation (MR), identify adverse cardiac remodeling and its prognostic effect. The aim is to provide different insights regarding clinical decision-making and enhance the clinical outcomes of patients with MR.

Recent Findings

Cardiac remodeling and myocardial replacement fibrosis are observed frequently in the presence of substantial LV volume overload, particularly in cases with severe primary MR. CMR serves as a useful diagnostic imaging modality in assessing mitral regurgitation severity, early detection of cardiac remodeling, myocardial dysfunction, and myocardial fibrosis, enabling timely intervention before irreversible damage ensues.

Summary

Incorporating myocardial remodeling in terms of left ventricular (LV) dilatation and myocardial fibrosis with quantitative MR severity assessment by CMR may assist in defining optimal timing of intervention.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data Availability

No datasets were generated or analysed during the current study.

References

Papers of particular interest, published recently, have been highlighted as: •  Of importance •• Of major importance

  1. Nishimura RA, Vahanian A, Eleid MF, Mack MJ. Mitral valve disease–current management and future challenges. Lancet. 2016;387(10025):1324–34. https://doi.org/10.1016/S0140-6736(16)00558-4.

    Article  PubMed  Google Scholar 

  2. Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet. 2018;391:960–9. https://doi.org/10.1016/S0140-6736(18)30473-2.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382–94. https://doi.org/10.1016/S0140-6736(09)60692-9.

    Article  PubMed  Google Scholar 

  4. Ling LH, Enriquez-Sarano M, Seward JB, et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med. 1996;335:1417–23. https://doi.org/10.1056/NEJM199611073351902.

    Article  CAS  PubMed  Google Scholar 

  5. Grigioni F, Avierinos JF, Ling LH, et al. Atrial fibrillation complicating the course of degenerative mitral regurgitation: determinants and long-term outcome. J Am Coll Cardiol. 2002;40:84–92. https://doi.org/10.1016/s0735-1097(02)01922-8.

    Article  PubMed  Google Scholar 

  6. Tribouilloy C, Rusinaru D, Grigioni F, et al. Long-term mortality associated with left ventricular dysfunction in mitral regurgitation due to flail leaflets: a multicenter analysis. Circ Cardiovasc Imaging. 2014;7:363–70. https://doi.org/10.1161/CIRCIMAGING.113.001251.

    Article  PubMed  Google Scholar 

  7. Rossi A, Dini FL, Faggiano P, et al. Independent prognostic value of functional mitral regurgitation in patients with heart failure. A quantitative analysis of 1256 patients with ischaemic and non-ischaemic dilated cardiomyopathy. Heart. 2011;97:1675–80. https://doi.org/10.1136/hrt.2011.225789.

    Article  PubMed  Google Scholar 

  8. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med. 2005;352:875–83. https://doi.org/10.1056/NEJMoa041451.

    Article  CAS  PubMed  Google Scholar 

  9. Filsoufi F, Carpentier A. Principles of reconstructive surgery in degenerative mitral valve disease. Semin Thorac Cardiovasc Surg. 2007;19:103–10. https://doi.org/10.1053/j.semtcvs.2007.04.003.

    Article  PubMed  Google Scholar 

  10. Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, Barengo NC, Beaton AZ, Benjamin EJ, Benziger CP, Bonny A, Brauer M, Brodmann M, Cahill TJ, Carapetis J, Catapano AL, Chugh SS, Cooper LT, Coresh J, Criqui M, DeCleene N, Eagle KA, Emmons-Bell S, Feigin VL, Fernández-Solà J, Fowkes G, Gakidou E, Grundy SM, He FJ, Howard G, Hu F, Inker L, Karthikeyan G, Kassebaum N, Koroshetz W, Lavie C, Lloyd-Jones D, Lu HS, Mirijello A, Temesgen AM, Mokdad A, Moran AE, Muntner P, Narula J, Neal B, Ntsekhe M, Moraes de Oliveira G, Otto C, Owolabi M, Pratt M, Rajagopalan S, Reitsma M, Ribeiro ALP, Rigotti N, Rodgers A, Sable C, Shakil S, Sliwa-Hahnle K, Stark B, Sundström J, Timpel P, Tleyjeh IM, Valgimigli M, Vos T, Whelton PK, Yacoub M, Zuhlke L, Murray C, Fuster V; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. J Am Coll Cardiol. 2020;76(25):2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010. Erratum in: J Am Coll Cardiol. 2021 Apr 20;77(15):1958–1959. PMID: 33309175; PMCID: PMC7755038.

  11. Han YC, Peters DC, Salton CJ, Bzymek D, Nezafat R, Goddu B, et al. Cardiovascular magnetic resonance characterization of mitral valve prolapse. JACC Cardiovasc Imaging. 2008;1:294–303. https://doi.org/10.1016/j.jcmg.2008.01.013.

    Article  PubMed  Google Scholar 

  12. Basso C, Perazzolo Marra M, Rizzo S, De Lazzari M, Giorgi B, Cipriani A, et al. Arrhythmic mitral valve prolapse and sudden cardiac death. Circulation. 2015;132:556–66. https://doi.org/10.1161/CIRCULATIONAHA.115.016291.

    Article  PubMed  Google Scholar 

  13. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease The task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017;38:2739. https://doi.org/10.1093/eurheartj/ehx391.

    Article  PubMed  Google Scholar 

  14. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30:303–71. https://doi.org/10.1016/j.echo.2017.01.007.

    Article  PubMed  Google Scholar 

  15. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A, Toly C; ACC/AHA Joint Committee Members; O'Gara PT, Beckman JA, Levine GN, Al-Khatib SM, Armbruster A, Birtcher KK, Ciggaroa J, Deswal A, Dixon DL, Fleisher LA, de Las Fuentes L, Gentile F, Goldberger ZD, Gorenek B, Haynes N, Hernandez AF, Hlatky MA, Joglar JA, Jones WS, Marine JE, Mark D, Palaniappan L, Piano MR, Spatz ES, Tamis-Holland J, Wijeysundera DN, Woo YJ. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg. 2021;162(2):e183–e353. https://doi.org/10.1016/j.jtcvs.2021.04.002.

  16. Pennell DJ, Sechtem UP, Higgins CB, et al. Clinical indications for cardiovascular magnetic resonance (CMR): consensus panel report. Eur Heart J. 2004;25:1940–65. https://doi.org/10.1016/j.ehj.2004.06.040.

    Article  PubMed  Google Scholar 

  17. Masci PG, Dymarkowski S, Bogaert J. Valvular heart disease: what does cardiovascular MRI add? Eur Radiol. 2008;18:187–208. https://doi.org/10.1007/s00330-007-0731-x.

    Article  Google Scholar 

  18. Cawley PJ, Maki JH, Otto CM. Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation. 2009;119:468–78. https://doi.org/10.1161/CIRCULATIONAHA.107.742486.

    Article  PubMed  Google Scholar 

  19. Nayak KS, Nielsen JF, Bernstein MA, et al. Cardiovascular magnetic resonance phase contrast imaging. J Cardiovasc Magn Reson. 2015;17:71. https://doi.org/10.1186/s12968-015-0172-7.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Myerson SG, d’Arcy J, Christiansen JP, Dobson LE, Mohiaddin R, Francis JM, Prendergast B, Greenwood JP, Karamitsos TD, Neubauer S. Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantification. Circulation. 2016;133(23):2287–96. https://doi.org/10.1161/CIRCULATIONAHA.115.017888.

    Article  PubMed  Google Scholar 

  21. Buchner S, Debl K, Poschenrieder F, et al. Cardiovascular magnetic resonance for direct assessment of anatomic regurgitant orifice in mitral regurgitation. Circ Cardiovasc Imaging. 2008;1:148–55. https://doi.org/10.1161/CIRCIMAGING.107.753103.

    Article  PubMed  Google Scholar 

  22. Chan KMJ, Wage R, Symmonds K, Rahman-Haley S, Mohiaddin RH, Firmin DN, et al. Towards comprehensive assessment of mitral regurgitation using cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2008;10:61. https://doi.org/10.1186/1532-429X-10-61.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gabriel RS, Kerr AJ, Raffel OC, Stewart RA, Cowan BR, Occleshaw CJ. Mapping of mitral regurgitant defects by cardiovascular magnetic resonance in moderate or severe mitral regurgitation secondary to mitral valve prolapse. J Cardiovasc Magn Reson. 2008;10:16. https://doi.org/10.1186/1532-429X-10-16.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wolff R, Uretsky S. Defining the left ventricular base in mitral valve prolapse: impact on systolic function and regurgitation. Int J Cardiovasc Imaging. 2020;36:2221–7. https://doi.org/10.1007/s10554-020-01927-0.

    Article  PubMed  Google Scholar 

  25. Hudsmith LE, Petersen SE, Francis JM, Robson MD, Neubauer S. Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J Cardiovasc Magn Reson. 2005;7:775–82. https://doi.org/10.1080/10976640500295516.

    Article  PubMed  Google Scholar 

  26. Penicka M, Vecera J, Mirica DC, Kotrc M, Kockova R, Van Camp G. Prognostic implications of magnetic resonance-derived quantification in asymptomatic patients with organic mitral regurgitation: comparison with Doppler echocardiography-derived integrative approach. Circulation. 2018;137:1349–60. https://doi.org/10.1161/CIRCULATIONAHA.117.029332.

    Article  PubMed  Google Scholar 

  27. Romero Daza A, Chokshi A, Pardo P, Maneiro N, Guijarro Contreras A, Larrañaga-Moreira JM, et al. Mitral valve prolapse morphofunctional features by cardiovascular magnetic resonance: more than just a valvular disease. J Cardiovasc Magn Reson. 2021;23:107. https://doi.org/10.1186/s12968-021-00800-w.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Cameli M, Lisi M, Righini FM, Massoni A, Natali BM, Focardi M, et al. Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol. 2013;111(4):595–601. https://doi.org/10.1016/j.amjcard.2012.10.049.

    Article  PubMed  Google Scholar 

  29. El-Tallawi KC, Kitkungvan D, Xu J, Cristini V, Yang EY, Quinones MA, et al. Resolving the disproportionate left ventricular enlargement in mitral valve prolapse due to barlow disease: insights from cardiovascular magnetic resonance. JACC Cardiovasc Imaging. 2021;14:573–84. https://doi.org/10.1016/j.jcmg.2020.08.029.

    Article  PubMed  Google Scholar 

  30. Levy F, Iacuzio L, Marechaux S, Civaia F, Dommerc C, Wautot F, et al. Influence of prolapse volume in mitral valve prolapse. Am J Cardiol. 2021;157:64–70. https://doi.org/10.1016/j.amjcard.2021.07.019.

    Article  PubMed  Google Scholar 

  31. Ahmed MI, Andrikopoulou E, Zheng J, Ulasova E, Pat B, Kelley EE, Powell PC, Denney TS Jr, Lewis C, Davies JE, Darley-Usmar V, Dell’Italia LJ. Interstitial Collagen Loss, Myocardial Remodeling, and Function in Primary Mitral Regurgitation. JACC Basic Transl Sci. 2022;7(10):973–81. https://doi.org/10.1016/j.jacbts.2022.04.014.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Croisille P, Revel D, Saeed M. Contrast agents and cardiac MR imaging of myocardial ischemia: from bench to bedside. Eur Radiol. 2006;16:1951–63. https://doi.org/10.1007/s00330-006-0244-z.

    Article  PubMed  Google Scholar 

  33. Holtackers RJ, Van De Heyning CM, Chiribiri A, et al. Dark-blood late gadolinium enhancement cardiovascular magnetic resonance for improved detection of subendocardial scar: a review of current techniques. J Cardiovasc Magn Reson. 2021;23:96. https://doi.org/10.1186/s12968-021-00777-6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Van De Heyning CM, Holtackers RJ, Nazir MS, Grapsa J, Demetrescu C, Pype L, et al. Dark-blood late gadolinium enhancement CMR improves detection of papillary muscle fibrosis in patients with mitral valve prolapse. Eur J Radiol. 2022;147: 110118. https://doi.org/10.1016/j.ejrad.2021.110118.

    Article  PubMed  Google Scholar 

  35. Kim, et al. Flow-Independent Dark-blood DeLayed Enhancement (FIDDLE): validation of a novel black blood technique for the diagnosis of myocardial infarction. J Cardiovasc Magn Reson. 2016;18(Suppl 1). https://doi.org/10.1186/1532-429X-18-S1-O55.

  36. •• Kitkungvan D, Nabi F, Kim RJ, Bonow RO, Khan MA, Xu J, et al. Myocardial fibrosis in patients with primary mitral regurgitation with and without prolapse. J Am Coll Cardiol. 2018;72:823–34. https://doi.org/10.1016/j.jacc.2018.06.048. Findings from this study showed higher prevalence of LV fibrosis in patients with MVP compared to those without MVP and LV fibrosis may represent a risk marker for cardiac events.

    Article  PubMed  Google Scholar 

  37. •• Constant Dit Beaufils A-L, Huttin O, Jobbe-Duval A, Senage T, Filippetti L, Piriou N, et al. Replacement myocardial fibrosis in patients with mitral valve prolapse: relation to mitral regurgitation, ventricular remodeling, and arrhythmia. Circulation. 2021;143:1763–74. https://doi.org/10.1161/CIRCULATIONAHA.120.050214. This study showed that replacement myocardial fibrosis detected by LGE on CMR was independently associated with an increase in cardiovascular events (cardiac death, HF, new-onset AF, arterial embolism, and life-threatening ventricular arrhythmia) during follow-up reinforcing the prognostic interest of CMR in MVP/MR.

    Article  PubMed  Google Scholar 

  38. Nagata Y, Bertrand PB, Baliyan V, Kochav J, Kagan RD, Ujka K, Alfraidi H, van Kampen A, Morningstar JE, Dal-Bianco JP, Melnitchouk S, Holmvang G, Borger MA, Moore R, Hua L, Sultana R, Calle PV, Yum B, Guerrero JL, Neilan TG, Picard MH, Kim J, Delling FN, Hung J, Norris RA, Weinsaft JW, Levine RA. Abnormal Mechanics Relate to Myocardial Fibrosis and Ventricular Arrhythmias in Patients With Mitral Valve Prolapse. Circ Cardiovasc Imaging. 2023;16(4):e014963. https://doi.org/10.1161/CIRCIMAGING.122.014963.

    Article  PubMed  Google Scholar 

  39. Figliozzi S, Georgiopoulos G, Lopes PM, Bauer KB, Moura-Ferreira S, Tondi L, et al. Myocardial fibrosis at cardiac mri helps predict adverse clinical outcome in patients with mitral valve prolapse. Radiology. 2022;306:112–21. https://doi.org/10.1148/radiol.220454.

    Article  PubMed  Google Scholar 

  40. De Meester de Ravenstein C, Bouzin C, Lazam S, Boulif J, Amzulescu M, Melchior J, et al. Histological Validation of measurement of diffuse interstitial myocardial fibrosis by myocardial extravascular volume fraction from Modified Look-Locker imaging (MOLLI) T1 mapping at 3 T. J Cardiovasc Magn Reson. 2015;17:48. https://doi.org/10.1186/s12968-015-0150-0.

  41. Fontana M, White SK, Banypersad SM, Sado DM, Maestrini V, Flett AS, et al. Comparison of T1 mapping techniques for ECV quantification. Histological validation and reproducibility of ShMOLLI versus multibreath-hold T1 quantification equilibrium contrast CMR. J Cardiovasc Magn Reson. 2012;14:88. https://doi.org/10.1186/1532-429X-14-88.

  42. Kramer CM, Barkhausen J, Bucciarelli-Ducci C, Flamm SD, Kim RJ, Nagel E. Standardized cardiovascular magnetic resonance imaging (CMR) protocols: 2020 update. J Cardiovasc Magn Reson. 2020;22:17. https://doi.org/10.1186/s12968-020-00607-1.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Treibel TA, Fontana M, Maestrini V, Castelletti S, Rosmini S, Simpson J, et al. Automatic measurement of the myocardial interstitium: synthetic extracellular volume quantification without hematocrit sampling. JACC Cardiovasc Imaging. 2016;9:54–63. https://doi.org/10.1016/j.jcmg.2015.11.008.

    Article  PubMed  Google Scholar 

  44. • Kitkungvan D, Yang EY, El Tallawi KC, Nagueh SF, Nabi F, Khan MA, et al. Extracellular volume in primary mitral regurgitation. JACC Cardiovasc Imaging. 2021;14:1146–60. https://doi.org/10.1016/j.jcmg.2020.10.010. Findings of this study showed that diffuse interstitial fibrosis as inferred by ECV was associated with MR severity, regardless of primary MR etiology and that ECV was independently associated with symptoms related to MR and clinical events.

    Article  PubMed  Google Scholar 

  45. Kitkungvan D, Yang EY, El Tallawi KC, Nagueh SF, Nabi F, Khan MA, et al. Prognostic implications of diffuse interstitial fibrosis in asymptomatic primary mitral regurgitation. Circulation. 2019;140:2122–4. https://doi.org/10.1161/CIRCULATIONAHA.119.043250.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Liu B, Neil DAH, Bhabra M, Patel R, Barker TA, Nikolaidis N, et al. Reverse myocardial remodeling following valve repair in patients with chronic severe primary degenerative mitral regurgitation. JACC Cardiovasc Imaging. 2022;15:224–36. https://doi.org/10.1016/j.jcmg.2021.07.007.

    Article  PubMed  Google Scholar 

  47. el Ibrahim SH. Myocardial tagging by cardiovascular magnetic resonance: evolution of techniques–pulse sequences, analysis algorithms, and applications. J Cardiovasc Magn Reson. 2011;13:36. https://doi.org/10.1186/1532-429x-13-36.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Williams LK, Forero JF, Popovic ZB, Phelan D, Delgado D, Rakowski H, Wintersperger BJ, Thavendiranathan P. Patterns of CMR measured longitudinal strain and its association with late gadolinium enhancement in patients with cardiac amyloidosis and its mimics. J Cardiovasc Magn Reson. 2017;19(1):61. https://doi.org/10.1186/s12968-017-0376-0.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Pedrizzetti G, Claus P, Kilner PJ, Nagel E. Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson. 2016;18:51. https://doi.org/10.1186/s12968-016-0269-7.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Schuster A, Hor KN, Kowallick JT, Beerbaum P, Kutty S. Cardiovascular magnetic resonance myocardial feature tracking: concepts and clinical applications. Circ Cardiovasc Imaging. 2016;9:e004077. https://doi.org/10.1161/circimaging.115.004077.

    Article  PubMed  Google Scholar 

  51. Padiyath A, Gribben P, Abraham JR, et al. Echocardiography and cardiac magnetic resonance-based feature tracking in the assessment of myocardial mechanics in tetralogy of Fallot: an intermodality comparison. Echocardiography. 2013;30:203–10. https://doi.org/10.1111/echo.12016.

    Article  PubMed  Google Scholar 

  52. Morton G, Schuster A, Jogiya R, Kutty S, Beerbaum P, Nagel E. Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson. 2012;14:43. https://doi.org/10.1186/1532-429x-14-43.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Augustine D, Lewandowski AJ, Lazdam M, et al. Global and regional left ventricular myocardial deformation measures by magnetic resonance feature tracking in healthy volunteers: comparison with tagging and relevance of gender. J Cardiovasc Magn Reson. 2013;15:8. https://doi.org/10.1186/1532-429x-15-8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

Joanne Park is a scientific illustrator at Houston Methodist who received her master’s degree in medical illustration at the Rochester Institute of Technology and received her bachelor’s in biology from Boston University. As a medical illustrator and 3D generalist, she collaborates with researchers and allied health services to help illustrate their often dense and cutting-edge research or procedures.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin, suite 1801, Houston, TX, 77030, USA

    Amr Darwish, Akila Bersali, Mujtaba Saeed, Aneesh Dhore, Dimitrios Maragiannis, K. Carlos El-Tallawi & Dipan J. Shah

Authors
  1. Amr Darwish
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Akila Bersali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mujtaba Saeed
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aneesh Dhore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dimitrios Maragiannis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Carlos El-Tallawi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dipan J. Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A.D, A.B and M.S wrote the main manuscript. A.D and D.M prepared the figures and the table. All authors reviewed the manuscript.

Corresponding author

Correspondence to Dipan J. Shah.

Ethics declarations

Conflict of Interest

The authors declare no conflict of interests.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Darwish, A., Bersali, A., Saeed, M. et al. Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Primary Mitral Regurgitation. Curr Cardiol Rep (2024). https://doi.org/10.1007/s11886-024-02069-8

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11886-024-02069-8

Keywords

Search

Navigation