Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies
- First Online:
To determine whether cardiac computed tomography (MDCT) can differentiate between functional and valvular aetiologies of chronic mitral regurgitation (MR) compared with echocardiography (TTE).
Twenty-seven patients with functional or valvular MR diagnosed by TTE and 19 controls prospectively underwent cardiac MDCT. The morphological appearance of the mitral valve (MV) leaflets, MV geometry, MV leaflet angle, left ventricular (LV) sphericity and global/regional wall motion were analysed. The coronary arteries were evaluated for obstructive atherosclerosis.
All control and MR cases were correctly identified by MDCT. Significant differences were detected between valvular and control groups for anterior leaflet length (30 ± 7 mm vs. 22 ± 4 mm, P < 0.02) and thickness (3.0 ± 1 mm vs. 2.2 ± 1 mm, P < 0.01). High-grade coronary stenosis was detected in all patients with functional MR compared with no controls (P < 0.001). Significant differences in those with/without MV prolapse were detected in MV tent area (−1.0 ± 0.6 mm vs. 1.3 ± 0.9 mm, P < 0.0001) and MV tent height (−0.7 ± 0.3 mm vs. 0.8 ± 0.8 mm, P < 0.0001). Posterior leaflet angle was significantly greater for functional MR (37.9 ± 19.1° vs. 22.9 ± 14°, P < 0.018) and less for valvular MR (0.6 ± 35.5° vs. 22.9 ± 14°, P < 0.017). Sensitivity, specificity, and positive and negative predictive values of MDCT were 100%, 95%, 96% and 100%.
Cardiac MDCT allows the differentiation between functional and valvular causes of MR.
KeywordsCardiomyopathy Dilated/complications Mitral valve/anatomy Mitral valve insufficiency/aetiology Computed tomography Coronary artery disease
- 1.Topol EJ, Califf RM, Prystowsky EN, Thomas JD, Thompson PD (2006) Cardiac tumors. The topol solution: textbook of cardiovascular medicine. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
- 4.Bonow RO, Carabello B, de Leon AC Jr, Edmunds LH Jr, Fedderly BJ, Freed MD, Gaasch WH, McKay CR, Nishimura RA, O’Gara PT, O’Rourke RA, Rahimtoola SH, Ritchie JL, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Gibbons RJ, Russell RO, Ryan TJ, Smith SC Jr (1998) Guidelines for the management of patients with valvular heart disease: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). Circulation 98:1949–1984PubMedGoogle Scholar
- 5.Kwan J, Shiota T, Agler DA, Popovic ZB, Qin JX, Gillinov MA, Stewart WJ, Cosgrove DM, McCarthy PM, Thomas JD (2003) Geometric differences of the mitral apparatus between ischemic and dilated cardiomyopathy with significant mitral regurgitation: real-time three-dimensional echocardiography study. Circulation 107:1135–1140CrossRefPubMedGoogle Scholar
- 6.Ahmad RM, Gillinov AM, McCarthy PM, Blackstone EH, Apperson-Hansen C, Qin JX, Agler D, Shiota T, Cosgrove DM (2004) Annular geometry and motion in human ischemic mitral regurgitation: novel assessment with three-dimensional echocardiography and computer reconstruction. Ann Thorac Surg 78:2063–2068; discussion 2068CrossRefPubMedGoogle Scholar
- 9.Monin JL, Dehant P, Roiron C, Monchi M, Tabet JY, Clerc P, Fernandez G, Houel R, Garot J, Chauvel C, Gueret P (2005) Functional assessment of mitral regurgitation by transthoracic echocardiography using standardized imaging planes diagnostic accuracy and outcome implications. J Am Coll Cardiol 46:302–309CrossRefPubMedGoogle Scholar
- 14.Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, Pennell DJ, Rumberger JA, Ryan T, Verani MS (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: a statement for healthcare professionals from the Cardiac Imaging Committee of the Council on Clinical Cardiology of the American Heart Association. Circulation 105:539–42CrossRefPubMedGoogle Scholar
- 15.Palmieri V, Okin PM, Bella JN, Gerdts E, Wachtell K, Gardin J, Papademetriou V, Nieminen MS, Dahlof B, Devereux RB (2003) Echocardiographic wall motion abnormalities in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. Hypertension 41:75–82CrossRefPubMedGoogle Scholar
- 17.Anderson JL, Horne BD, Pennell DJ (2005) Atrial dimensions in health and left ventricular disease using cardiovascular magnetic resonance. J Cardiovasc Magnetic Reson 7:671–675Google Scholar
- 23.Cury RC, Nieman K, Shapiro MD, Butler J, Nomura CH, Ferencik M, Hoffmann U, Abbara S, Jassal DS, Yasuda T, Gold HK, Jang IK, Brady TJ (2008) Comprehensive assessment of myocardial perfusion defects, regional wall motion, and left ventricular function by using 64-section multidetector CT. Radiology 248:466–475CrossRefPubMedGoogle Scholar
- 24.Alkadhi H, Bettex D, Wildermuth S, Baumert B, Plass A, Grunenfelder J, Desbiolles L, Marincek B, Boehm T (2005) Dynamic cine imaging of the mitral valve with 16-MDCT: a feasibility study. Am J Roentgenol 185:636–646Google Scholar
- 27.Kumanohoso T, Otsuji Y, Yoshifuku S, Matsukida K, Koriyama C, Kisanuki A, Minagoe S, Levine RA, Tei C (2003) Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg 125:135–143CrossRefPubMedGoogle Scholar
- 29.Liel-Cohen N, Guerrero JL, Otsuji Y, Handschumacher MD, Rudski LG, Hunziker PR, Tanabe H, Scherrer-Crosbie M, Sullivan S, Levine RA (2000) Design of a new surgical approach for ventricular remodeling to relieve ischemic mitral regurgitation: insights from 3-dimensional echocardiography. Circulation 101:2756–2763PubMedGoogle Scholar