Magnetic Resonance Unit, National Institute of Cardiology, ul. Alpejska 42, 04-628, Warsaw, Poland.
Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland.
Sci Rep. 2021 Oct 6;11(1):19902. doi: 10.1038/s41598-021-99446-y.
Mitral regurgitation (MR), which is one of the factors responsible for heart failure symptoms and the development of atrial fibrillation, is an important feature of hypertrophic cardiomyopathy (HCM), and its presence affects which treatment options are chosen. Although cardiac magnetic resonance imaging (MRI) is considered the reference standard for assessing the regurgitant volume (RV) and fraction (RF), echocardiography is the most common method for assessing MR severity. Accordingly, the aim of this study was to compare the results of echocardiography and cardiac MRI for assessing MR severity in a cohort of patients with HCM. MR severity was assessed in 53 patients using cardiac MRI by determining the mitral RV (MRV) and mitral RF (MRF). The results were graded according to thresholds recommended in current guidelines. MR severity assessed by echocardiography was graded by integrating indices of severity. Greater than mild MR, as assessed using echocardiography, was present in 22 patients (41.5%) with HCM and in none of the control patients (p = 0.001). In all, 31 patients (58.5%) had no more than mild MR. When MR severity was assessed using different methods, either moderate (kappa = 0.44, 95% confidence interval = 0.21-0.67), poor or no agreement was found between MRI-derived and echocardiography-derived grades. HCM patients with echocardiography-derived moderate and severe MR had similar median MRVs and MRFs (p = 0.59 and p = 0.11, respectively). In HCM patients, cardiac MRI and echocardiography were at most in modest agreement in assessing MR severity. Importantly, echocardiography-derived moderate and severe MR were not distinguishable by either MRV or MRF.
二尖瓣反流（MR）是心力衰竭症状和心房颤动发展的原因之一，也是肥厚型心肌病（HCM）的一个重要特征，其存在影响了治疗选择。尽管心脏磁共振成像（MRI）被认为是评估反流量（RV）和分数（RF）的参考标准，但超声心动图是评估 MR 严重程度最常用的方法。因此，本研究旨在比较超声心动图和心脏 MRI 评估 HCM 患者 MR 严重程度的结果。通过确定二尖瓣 RV（MRV）和二尖瓣 RF（MRF），对 53 例 HCM 患者进行心脏 MRI 评估 MR 严重程度。根据现行指南推荐的标准来分级。通过整合严重程度指数来评估超声心动图评估的 MR 严重程度。使用超声心动图评估，22 例（41.5%）HCM 患者存在中度以上 MR，而对照组患者无一例存在（p = 0.001）。共有 31 例（58.5%）患者的 MR 程度不超过轻度。当使用不同方法评估 MR 严重程度时，MRI 与超声心动图分级之间的一致性较差或无一致性（kappa 值为 0.44，95%置信区间为 0.21-0.67）。在超声心动图评估为中度和重度 MR 的 HCM 患者中，MRV 和 MRF 的中位数相似（p = 0.59 和 p = 0.11）。在 HCM 患者中，心脏 MRI 和超声心动图在评估 MR 严重程度方面最多只有中等程度的一致性。重要的是，无论是通过 MRV 还是 MRF，超声心动图评估的中度和重度 MR 都无法区分。
