Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity

A prospective multicenter trial

Seth Uretsky, Linda Gillam, Roberto Lang, Farooq A. Chaudhry, Edgar Argulian, Azhar Supariwala, Srinivasa Gurram, Kavya Jain, Marjorie Subero, James J. Jang, Randy Cohen, Steven D. Wolff

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Background The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important. Objectives The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard. Methods In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume. Results Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p < 0.0001), and there was a poorer correlation in the subset of patients sent for surgery (r = 0.4; p = 0.01). There was a strong correlation between post-surgical LV remodeling and MR severity as assessed by MRI (r = 0.85; p < 0.0001), and no correlation between post-surgical LV remodeling and MR severity as assessed by echocardiography (r = 0.32; p = 0.1). Conclusions The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery.

Original languageEnglish (US)
Pages (from-to)1078-1088
Number of pages11
JournalJournal of the American College of Cardiology
Volume65
Issue number11
DOIs
StatePublished - Mar 24 2015

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Mitral Valve Insufficiency
Multicenter Studies
Echocardiography
Magnetic Resonance Imaging
Ventricular Remodeling
Mitral Valve
Stroke Volume
Guidelines

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Uretsky, Seth ; Gillam, Linda ; Lang, Roberto ; Chaudhry, Farooq A. ; Argulian, Edgar ; Supariwala, Azhar ; Gurram, Srinivasa ; Jain, Kavya ; Subero, Marjorie ; Jang, James J. ; Cohen, Randy ; Wolff, Steven D. / Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity : A prospective multicenter trial. In: Journal of the American College of Cardiology. 2015 ; Vol. 65, No. 11. pp. 1078-1088.
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abstract = "Background The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important. Objectives The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard. Methods In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume. Results Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p < 0.0001), and there was a poorer correlation in the subset of patients sent for surgery (r = 0.4; p = 0.01). There was a strong correlation between post-surgical LV remodeling and MR severity as assessed by MRI (r = 0.85; p < 0.0001), and no correlation between post-surgical LV remodeling and MR severity as assessed by echocardiography (r = 0.32; p = 0.1). Conclusions The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery.",
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Uretsky, S, Gillam, L, Lang, R, Chaudhry, FA, Argulian, E, Supariwala, A, Gurram, S, Jain, K, Subero, M, Jang, JJ, Cohen, R & Wolff, SD 2015, 'Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity: A prospective multicenter trial', Journal of the American College of Cardiology, vol. 65, no. 11, pp. 1078-1088. https://doi.org/10.1016/j.jacc.2014.12.047

Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity : A prospective multicenter trial. / Uretsky, Seth; Gillam, Linda; Lang, Roberto; Chaudhry, Farooq A.; Argulian, Edgar; Supariwala, Azhar; Gurram, Srinivasa; Jain, Kavya; Subero, Marjorie; Jang, James J.; Cohen, Randy; Wolff, Steven D.

In: Journal of the American College of Cardiology, Vol. 65, No. 11, 24.03.2015, p. 1078-1088.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Discordance between echocardiography and MRI in the assessment of mitral regurgitation severity

T2 - A prospective multicenter trial

AU - Uretsky, Seth

AU - Gillam, Linda

AU - Lang, Roberto

AU - Chaudhry, Farooq A.

AU - Argulian, Edgar

AU - Supariwala, Azhar

AU - Gurram, Srinivasa

AU - Jain, Kavya

AU - Subero, Marjorie

AU - Jang, James J.

AU - Cohen, Randy

AU - Wolff, Steven D.

PY - 2015/3/24

Y1 - 2015/3/24

N2 - Background The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important. Objectives The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard. Methods In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume. Results Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p < 0.0001), and there was a poorer correlation in the subset of patients sent for surgery (r = 0.4; p = 0.01). There was a strong correlation between post-surgical LV remodeling and MR severity as assessed by MRI (r = 0.85; p < 0.0001), and no correlation between post-surgical LV remodeling and MR severity as assessed by echocardiography (r = 0.32; p = 0.1). Conclusions The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery.

AB - Background The decision to undergo mitral valve surgery is often made on the basis of echocardiographic criteria and clinical assessment. Recent changes in treatment guidelines recommending surgery in asymptomatic patients make the accurate assessment of mitral regurgitation (MR) severity even more important. Objectives The purpose of this study was to compare echocardiography and magnetic resonance imaging (MRI) in the assessment of MR severity using the degree of left ventricular (LV) remodeling after surgery as the reference standard. Methods In this prospective multicenter trial, MR severity was assessed in 103 patients using both echocardiography and MRI. Thirty-eight patients subsequently had isolated mitral valve surgery, and 26 of these had an additional MRI performed 5 to 7 months after surgery. The pre-surgical estimate of regurgitant severity was correlated with the postoperative decrease in LV end-diastolic volume. Results Agreement between MRI and echocardiographic estimates of MR severity was modest in the overall cohort (r = 0.6; p < 0.0001), and there was a poorer correlation in the subset of patients sent for surgery (r = 0.4; p = 0.01). There was a strong correlation between post-surgical LV remodeling and MR severity as assessed by MRI (r = 0.85; p < 0.0001), and no correlation between post-surgical LV remodeling and MR severity as assessed by echocardiography (r = 0.32; p = 0.1). Conclusions The data suggest that MRI is more accurate than echocardiography in assessing the severity of MR. MRI should be considered in those patients when MR severity as assessed by echocardiography is influencing important clinical decisions, such as the decision to undergo MR surgery.

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