Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging

Mark Aplin; Kasper Kyhl; Jenny Bjerre; Nikolaj Ihlemann; John P Greenwood; Sven Plein; Akhlaque Uddin; Niels Tønder; Nis Baun Høst; Malin Glindvad Ahlström; Jens Hove; Christian Hassager; Kasper Iversen; Niels G. Vejlstrup; Per Lav Madsen

doi:10.1093/ehjci/jev321

Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging

Mark Aplin, Kasper Kyhl, Jenny Bjerre, Nikolaj Ihlemann, John P Greenwood, Sven Plein, Akhlaque Uddin, Niels Tønder, Nis Baun Høst, Malin Glindvad Ahlström, Jens Hove, Christian Hassager, Kasper Iversen, Niels G. Vejlstrup, Per Lav Madsen

18 Citations (Scopus)

Abstract

Aims: Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flowand cardiac chamber volume quantification.We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MI_Vol) related to severe MI. Methods and results: In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Ao_flow). With increasing MI severity, MIVol, left heart volumes, and pulmonary venous diameters increased (P < 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MI_Vol > 40 mL, MI regurgitant fraction > 0.30, LV end-diastolic volume (LVEDV_(i)) > 108 mL m^-2, and a total left heart volume > 188 mL m^-2 with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio > 1.2. In severe MI, LV ejection fraction was unaffected, but the Ao_flow and the peak ejection rate indexed to LVEDV were lowered (P < 0.05). In surgical patients, the MIVol correlated to the decrease in LV dimension after valve surgery (P < 0.02). Conclusion: CMR provides a reproducible quantitative technique for evaluation of MI, as MI_Vol and cardiac chamber volumes can be held against diagnostic cut-off values. The Ao_flow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.

Original language	English
Journal	European Heart Journal Cardiovascular Imaging
Volume	17
Issue number	8
Pages (from-to)	863-870
Number of pages	8
ISSN	2047-2404
DOIs	https://doi.org/10.1093/ehjci/jev321
Publication status	Published - Aug 2016

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Aplin, M., Kyhl, K., Bjerre, J., Ihlemann, N., Greenwood, J. P., Plein, S., Uddin, A., Tønder, N., Høst, N. B., Ahlström, M. G., Hove, J., Hassager, C., Iversen, K., Vejlstrup, N. G., & Madsen, P. L. (2016). Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging. European Heart Journal Cardiovascular Imaging, 17(8), 863-870. https://doi.org/10.1093/ehjci/jev321

Aplin, M, Kyhl, K, Bjerre, J, Ihlemann, N, Greenwood, JP, Plein, S, Uddin, A, Tønder, N, Høst, NB, Ahlström, MG, Hove, J , Hassager, C , Iversen, K, Vejlstrup, NG & Madsen, PL 2016, 'Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging', European Heart Journal Cardiovascular Imaging, vol. 17, no. 8, pp. 863-870. https://doi.org/10.1093/ehjci/jev321

@article{9d46997689764c108315cc5b672107e1,

title = "Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging",

abstract = "Aims: Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flowand cardiac chamber volume quantification.We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MIVol) related to severe MI. Methods and results: In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Aoflow). With increasing MI severity, MIVol, left heart volumes, and pulmonary venous diameters increased (P < 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MIVol > 40 mL, MI regurgitant fraction > 0.30, LV end-diastolic volume (LVEDV(i)) > 108 mL m-2, and a total left heart volume > 188 mL m-2 with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio > 1.2. In severe MI, LV ejection fraction was unaffected, but the Aoflow and the peak ejection rate indexed to LVEDV were lowered (P < 0.05). In surgical patients, the MIVol correlated to the decrease in LV dimension after valve surgery (P < 0.02). Conclusion: CMR provides a reproducible quantitative technique for evaluation of MI, as MIVol and cardiac chamber volumes can be held against diagnostic cut-off values. The Aoflow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.",

author = "Mark Aplin and Kasper Kyhl and Jenny Bjerre and Nikolaj Ihlemann and Greenwood, {John P} and Sven Plein and Akhlaque Uddin and Niels T{\o}nder and H{\o}st, {Nis Baun} and Ahlstr{\"o}m, {Malin Glindvad} and Jens Hove and Christian Hassager and Kasper Iversen and Vejlstrup, {Niels G.} and Madsen, {Per Lav}",

year = "2016",

month = aug,

doi = "10.1093/ehjci/jev321",

language = "English",

volume = "17",

pages = "863--870",

journal = "European Heart Journal Cardiovascular Imaging",

issn = "2047-2404",

publisher = "Oxford University Press",

number = "8",

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TY - JOUR

T1 - Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging

AU - Aplin, Mark

AU - Kyhl, Kasper

AU - Bjerre, Jenny

AU - Ihlemann, Nikolaj

AU - Greenwood, John P

AU - Plein, Sven

AU - Uddin, Akhlaque

AU - Tønder, Niels

AU - Høst, Nis Baun

AU - Ahlström, Malin Glindvad

AU - Hove, Jens

AU - Hassager, Christian

AU - Iversen, Kasper

AU - Vejlstrup, Niels G.

AU - Madsen, Per Lav

PY - 2016/8

Y1 - 2016/8

N2 - Aims: Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flowand cardiac chamber volume quantification.We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MIVol) related to severe MI. Methods and results: In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Aoflow). With increasing MI severity, MIVol, left heart volumes, and pulmonary venous diameters increased (P < 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MIVol > 40 mL, MI regurgitant fraction > 0.30, LV end-diastolic volume (LVEDV(i)) > 108 mL m-2, and a total left heart volume > 188 mL m-2 with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio > 1.2. In severe MI, LV ejection fraction was unaffected, but the Aoflow and the peak ejection rate indexed to LVEDV were lowered (P < 0.05). In surgical patients, the MIVol correlated to the decrease in LV dimension after valve surgery (P < 0.02). Conclusion: CMR provides a reproducible quantitative technique for evaluation of MI, as MIVol and cardiac chamber volumes can be held against diagnostic cut-off values. The Aoflow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.

AB - Aims: Evaluation of patients with primary mitral valve insufficiency (MI) is best supported by quantitative measures. Cardiovascular magnetic resonance imaging (CMR) offers flowand cardiac chamber volume quantification.We studied cardiac remodelling with CMR to determine MI regurgitation volumes (MIVol) related to severe MI. Methods and results: In total, 24, 20, and 28 patients determined to have mild, moderate, and severe primary MI, respectively, were studied. Combining cine stacks with phase-contrast velocity mapping across the ascending aorta, CMR-determined MIVol was reproducibly obtained as the difference between left ventricular (LV) stroke volume and aortic forward flow (Aoflow). With increasing MI severity, MIVol, left heart volumes, and pulmonary venous diameters increased (P < 0.01). Severe MI with LV end-systolic diameter of 40 mm was signified by MIVol > 40 mL, MI regurgitant fraction > 0.30, LV end-diastolic volume (LVEDV(i)) > 108 mL m-2, and a total left heart volume > 188 mL m-2 with dilated pulmonary veins and a LVEDV/right ventricular EDV ratio > 1.2. In severe MI, LV ejection fraction was unaffected, but the Aoflow and the peak ejection rate indexed to LVEDV were lowered (P < 0.05). In surgical patients, the MIVol correlated to the decrease in LV dimension after valve surgery (P < 0.02). Conclusion: CMR provides a reproducible quantitative technique for evaluation of MI, as MIVol and cardiac chamber volumes can be held against diagnostic cut-off values. The Aoflow and peak ejection rate indexed to LVEDV may reveal early LV systolic dysfunction in patients with severe MI. Severe MI is related to lower MI regurgitation volume and fraction than previously believed.

U2 - 10.1093/ehjci/jev321

DO - 10.1093/ehjci/jev321

M3 - Journal article

C2 - 26758406

SN - 2047-2404

VL - 17

SP - 863

EP - 870

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

IS - 8

ER -

Cardiac remodelling and function with primary mitral valve insufficiency studied by magnetic resonance imaging

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