Advertisement

Direct and indirect quantification of mitral regurgitation with cardiovascular magnetic resonance, and the effect of heart rate variability

  • Saul G. Myerson
  • Jane M. Francis
  • Stefan Neubauer
Research Article

Abstract

Object

Quantifying mitral regurgitation with cardiovascular magnetic resonance (CMR) involves indirect calculation, which increases the potential for error. We examined a direct quantification method using velocity mapping across the mitral valve, which may be less susceptible to error, and also examined the effect of heart rate variability on both techniques.

Materials and Methods

Fifty-five patients underwent mitral regurgitation quantification with CMR by the direct method and two indirect methods—the standard method subtracting aortic flow (assessed by velocity mapping) from left ventricular stroke volume (assessed by cine imaging) and the ‘volumetric’ method using the difference between left and right ventricular stroke volumes. The methods were compared using Bland–Altman analyses.

Results

Patients with low heart rate variability (beat-to-beat variability <30 bpm; n = 44) showed good agreement between direct and indirect methods (95% confidence limits for the difference between measurements ±16.7ml/11.8% regurgitant fraction for the standard method; ±21.7ml/15.4% for the volumetric method), with no significant offset (mean difference +2.8 ml/+1.9% for standard and +3.1ml/+2.3% for volumetric methods). Patients with high heart rate variability (>30 bpm; n = 11) showed poor agreement between techniques (95% limits ±80.3ml/56.0%) and significant offset (mean difference +31.7ml/+19.5%).

Conclusion

Direct quantification of mitral regurgitation with CMR compares well with indirect methods for patients with low heart rate variability, involves fewer calculations and is quick. All CMR measurements that use velocity mapping may be inaccurate, however, in patients with highly irregular rhythms and should be avoided in these patients.

Keywords

Mitral regurgitation Magnetic resonance imaging Blood flow velocity Phase-contrast imaging 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, Lehman B, Benjamin EJ (1999) Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the framingham heart study). Am J Cardiol 83: 897–902CrossRefPubMedGoogle Scholar
  2. 2.
    Bonow RO, Carabello BA, Kanu C, de Leon AC, Jr., Faxon DP, Freed MD, Gaasch WH, Lytle BW, Nishimura RA, O’Gara PT, O’Rourke RA, Otto CM, Shah PM, Shanewise JS, Smith SC, Jr., Jacobs AK, Adams CD, Anderson JL, Antman EM, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Hunt SA, Lytle BW, Nishimura R, Page RL, Riegel B (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. Circulation 114:e84–231Google Scholar
  3. 3.
    Tribouilloy CM, Enriquez-Sarano M, Schaff HV, Orszulak TA, Bailey KR, Tajik AJ, Frye RL (1999) Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications. Circulation 99: 400–405PubMedGoogle Scholar
  4. 4.
    Enriquez-Sarano M (2002) Timing of mitral valve surgery. Heart 87: 79–85CrossRefPubMedGoogle Scholar
  5. 5.
    Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, Kraft CD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA, Rakowski H, Stewart WJ, Waggoner A, Weissman NJ (2003) Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and doppler echocardiography. J Am Soc Echocardiogr 16: 777–802CrossRefPubMedGoogle Scholar
  6. 6.
    Kon MW, Myerson SG, Moat NE, Pennell DJ (2004) Quantification of regurgitant fraction in mitral regurgitation by cardiovascular magnetic resonance: comparison of techniques. J Heart Valve Dis 13: 600–607PubMedGoogle Scholar
  7. 7.
    Enriquez-Sarano M, Miller FA Jr., Hayes SN, Bailey KR, Tajik AJ, Seward JB (1995) Effective mitral regurgitant orifice area: clinical use and pitfalls of the proximal isovelocity surface area method. J Am Coll Cardiol 25: 703–709CrossRefPubMedGoogle Scholar
  8. 8.
    Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, Detaint D, Capps M, Nkomo V, Scott C, Schaff HV, Tajik AJ (2005) Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Engl J Med 352: 875–883CrossRefPubMedGoogle Scholar
  9. 9.
    Marsan NA, Westenberg JJ, Ypenburg C, Delgado V, van Bommel RJ, Roes SD, Nucifora G, van der Geest RJ, de Roos A, Reiber JC, Schalij MJ, Bax JJ (2009) Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance. JACC Cardiovasc Imaging 2: 1245–1252CrossRefPubMedGoogle Scholar
  10. 10.
    Fujita N, Chazouilleres AF, Hartiala JJ, O’Sullivan M, Heidenreich P, Kaplan JD, Sakuma H, Foster E, Caputo GR, Higgins CB (1994) Quantification of mitral regurgitation by velocity-encoded cine nuclear magnetic resonance imaging. J Am Coll Cardiol 23: 951–958CrossRefPubMedGoogle Scholar
  11. 11.
    Chatzimavroudis GP, Oshinski JN, Pettigrew RI, Walker PG, Franch RH, Yoganathan AP (1998) Quantification of mitral regurgitation with MR phase-velocity mapping using a control volume method. J Magn Reson Imaging 8: 577–582CrossRefPubMedGoogle Scholar
  12. 12.
    Oshinski JN, Ku DN, Bohning DE, Pettigrew RI (1992) Effects of acceleration on the accuracy of MR phase velocity measurements. J Magn Reson Imaging 2: 665–670CrossRefPubMedGoogle Scholar
  13. 13.
    Hamilton CA, Moran PR, Santago P, Rajala SA 2nd (1994) Effects of intravoxel velocity distributions on the accuracy of the phase-mapping method in phase-contrast MR angiography. J Magn Reson Imaging 4: 752–755CrossRefPubMedGoogle Scholar
  14. 14.
    Nishimura DG, Jackson JI, Pauly JM (1991) On the nature and reduction of the displacement artifact in flow images. Magn Reson Med 22: 481–492CrossRefPubMedGoogle Scholar
  15. 15.
    O’Brien KR, Myerson SG, Cowan BR, Young AA, Robson MD (2009) Phase contrast ultrashort TE: a more reliable technique for measurement of high-velocity turbulent stenotic jets. Magn Reson Med 62: 626–636CrossRefPubMedGoogle Scholar
  16. 16.
    Lorenz CH, Walker ES, Morgan VL, Klein SS, Graham TP Jr. (1999) Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J Cardiovasc Magn Reson 1: 7–21CrossRefPubMedGoogle Scholar
  17. 17.
    Sondergaard L, Lindvig K, Hildebrandt P, Thomsen C, Stahlberg F, Joen T, Henriksen O (1993) Quantification of aortic regurgitation by magnetic resonance velocity mapping. Am Heart J 125: 1081–1090CrossRefPubMedGoogle Scholar
  18. 18.
    Kilner PJ, Gatehouse PD, Firmin DN (2007) Flow measurement by magnetic resonance: a unique asset worth optimising. J Cardiovasc Magn Reson 9: 723–728CrossRefPubMedGoogle Scholar
  19. 19.
    Kozerke S, Schwitter J, Pedersen EM, Boesiger P (2001) Aortic and mitral regurgitation: quantification using moving slice velocity mapping. J Magn Reson Imaging 14: 106–112CrossRefPubMedGoogle Scholar
  20. 20.
    Westenberg JJ, Doornbos J, Versteegh MI, Bax JJ, van der Geest RJ, de Roos A, Dion RA, Reiber JH (2005) Accurate quantitation of regurgitant volume with MRI in patients selected for mitral valve repair. Eur J Cardiothorac Surg 27:462–466 discussion 467Google Scholar
  21. 21.
    Hundley WG, Meshack BM, Willett DL, Sayad DE, Lange RA, Willard JE, Landau C, Hillis LD, Peshock RM (1996) Comparison of quantitation of left ventricular volume, ejection fraction, and cardiac output in patients with atrial fibrillation by cine magnetic resonance imaging versus invasive measurements. Am J Cardiol 78: 1119–1123CrossRefPubMedGoogle Scholar

Copyright information

© ESMRMB 2010

Authors and Affiliations

  • Saul G. Myerson
    • 1
  • Jane M. Francis
    • 1
  • Stefan Neubauer
    • 1
  1. 1.The University of Oxford Centre for Clinical Magnetic Resonance Research (OCMR)Department of Cardiovascular Medicine, John Radcliffe HospitalOxfordUK

Personalised recommendations