Department of Cardiovascular Medicine, Morristown Medical Center, Morristown, New Jersey.
Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
J Am Coll Cardiol. 2015 Mar 24;65(11):1078-88. doi: 10.1016/j.jacc.2014.12.047.
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.
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.
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.
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).
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.
二尖瓣手术的决策通常基于超声心动图标准和临床评估。最近，治疗指南的变化建议对无症状患者进行手术，这使得准确评估二尖瓣反流（MR）严重程度变得更加重要。
本研究旨在比较超声心动图和磁共振成像（MRI）在评估 MR 严重程度方面的差异，以手术前后左心室（LV）重构程度作为参考标准。
在这项前瞻性多中心试验中，103 例患者同时接受超声心动图和 MRI 评估 MR 严重程度。38 例患者随后接受了单纯二尖瓣手术，其中 26 例患者在手术后 5-7 个月进行了额外的 MRI 检查。术前反流严重程度的估计与术后 LV 舒张末期容积的减少相关。
整体队列中 MRI 和超声心动图评估 MR 严重程度的一致性中等（r = 0.6；p < 0.0001），而在接受手术的患者亚组中相关性较差（r = 0.4；p = 0.01）。术后 LV 重构与 MRI 评估的 MR 严重程度之间存在很强的相关性（r = 0.85；p < 0.0001），而与超声心动图评估的 MR 严重程度之间无相关性（r = 0.32；p = 0.1）。
数据表明，MRI 比超声心动图更能准确评估 MR 的严重程度。在超声心动图评估的 MR 严重程度影响重要临床决策（如是否进行 MR 手术）时，应考虑使用 MRI。
