Buchner Stefan, Debl Kurt, Poschenrieder Florian, Feuerbach Stefan, Riegger Günter A J, Luchner Andreas, Djavidani Behrus
Klinik und Poliklinik für Innere Medizin II and Institut für Röntgendiagnostik, Klinikum der Universität Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany.
Circ Cardiovasc Imaging. 2008 Sep;1(2):148-55. doi: 10.1161/CIRCIMAGING.107.753103. Epub 2008 Jul 30.
In patients with mitral regurgitation (MR), assessment of the severity of valvular dysfunction is crucial. Recently, regurgitant orifice area has been proposed as the most useful indicator of the severity of MR. The purpose of our study was to determine whether planimetry of the anatomic regurgitant orifice (ARO) in patients with MR is feasible by cardiovascular magnetic resonance (CMR) and correlates with invasive catheterization and echocardiography effective regurgitant orifice [ECHO-ERO] by proximal isovelocity surface area.
Planimetry of ARO was performed with a 1.5-T CMR scanner using a breath-hold balanced gradient echo sequence true fast imaging with steady state precession (TrueFISP). CMR planimetry of ARO was possible in 35 of 38 patients and was closely correlated with angiographic grading (r=0.84, P<0.0001). In patients with MR grade > or =III on catheterization, CMR-ARO (0.60+/-0.29 cm(2) versus 0.30+/-0.19 cm(2), P<0.0001) as well as ECHO-ERO (0.49+/-0.17 cm(2) versus 0.27+/-0.10 cm(2)) were significantly elevated in comparison with MR grade <III. Further, CMR-ARO was closely correlated to CMR regurgitant fraction and volume (r=0.90 and r=0.91, P<0.0001, respectively) and catheterization regurgitant fraction and volume (r=0.86 and 0.83, P<0.0001, respectively). The correlation between CMR-ARO and ECHO-ERO was 0.81 (P<0.0001) and CMR slightly overestimated ECHO-ERO by 0.06 cm(2) (P<0.05). As assessed by receiver operating characteristic analysis, CMR-ARO at a threshold of 0.40 cm(2) detected MR grade > or =III as defined by catheterization, with a sensitivity and specificity of 94% and 94%, respectively.
CMR planimetry of the anatomic mitral regurgitant lesion in patients with MR is feasible and permits quantification of MR with good agreement with the accepted invasive and noninvasive methods. Direct measurement by CMR is a promising new method for the precise assessment of ARO area and the severity of MR.
在二尖瓣反流（MR）患者中，评估瓣膜功能障碍的严重程度至关重要。最近，反流口面积已被提议作为MR严重程度最有用的指标。我们研究的目的是确定通过心血管磁共振（CMR）对MR患者进行解剖反流口（ARO）面积的平面测量是否可行，以及其与侵入性导管检查和经近端等速表面积法测量的超声心动图有效反流口面积[ECHO - ERO]是否相关。
使用1.5-T CMR扫描仪，采用屏气平衡梯度回波序列稳态进动快速成像（TrueFISP）对ARO进行平面测量。38例患者中有35例可行CMR对ARO的平面测量，且与血管造影分级密切相关（r = 0.84，P < 0.0001）。在导管检查中MR分级≥III级的患者中，CMR - ARO（0.60±0.29 cm² 对 0.30±0.19 cm²，P < 0.0001）以及ECHO - ERO（0.49±0.17 cm² 对 0.27±0.10 cm²）与MR分级<III级的患者相比均显著升高。此外，CMR - ARO与CMR反流分数和反流容积密切相关（分别为r = 0.90和r = 0.91，P < 0.0001），与导管检查反流分数和反流容积也密切相关（分别为r = 0.86和0.83，P < 0.0001）。CMR - ARO与ECHO - ERO之间的相关性为0.81（P < 0.0001），且CMR对ECHO - ERO的估计略高0.06 cm²（P < 0.05）。通过受试者工作特征分析评估，CMR - ARO阈值为0.40 cm²时，检测导管检查定义的MR分级≥III级的敏感性和特异性分别为94%和94%。
CMR对MR患者二尖瓣反流解剖病变进行平面测量是可行的，并且能够对MR进行定量，与公认的侵入性和非侵入性方法具有良好的一致性。CMR直接测量是一种有前景的新方法，可用于精确评估ARO面积和MR的严重程度。
