Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA.
Department of Cardiovascular Medicine, Gagnon Cardiovascular Institute, Morristown Medical Center/Atlantic Health System, Morristown, New Jersey, USA.
JACC Cardiovasc Imaging. 2022 May;15(5):747-760. doi: 10.1016/j.jcmg.2021.10.006. Epub 2022 Jan 12.
The purpose of this study was to compare the American Society of Echocardiography (ASE) algorithm for assessing mitral regurgitation (MR) to cardiac magnetic resonance (CMR) and left ventricular (LV) remodeling following mitral intervention.
The ASE recommends integrating multiple echocardiographic parameters for assessing MR. The ASE guidelines include an algorithm that weighs the parameters and highlights those considered indicative of definitely mild or definitely severe MR.
We prospectively enrolled 152 (age 62 ± 13 years; 59% male) patients with degenerative MR who underwent ASE algorithm-guided echocardiographic and CMR grading of MR severity. Using the ASE algorithm, patients were graded as definitely mild, grade I, grade II, grade III, grade IV, or definitely severe MR. CMR MR volume was graded as mild (<30 mL), grade II moderate (30-44 mL), grade III moderate (45-59 mL), or severe (≥60 mL). A subgroup of 63 patients underwent successful mitral intervention, of whom 48 had postintervention CMR.
Only 52% of patients with definitely severe MR by the ASE algorithm had severe MR by CMR, and 10% had mild MR by CMR. There was an increase in post mitral intervention LV reverse remodeling with worsening MR severity using CMR (P < 0.0001) but not the ASE algorithm (P = 0.07). Severe MR by CMR was an independent predictor of post mitral intervention LV reverse remodeling and definitely severe MR by the ASE algorithm was not.
In patients with degenerative MR, agreement between CMR and the ASE algorithm was suboptimal. Severe MR by CMR was an independent predictor of post mitral intervention LV reverse remodeling, whereas definitely severe MR by the ASE algorithm was not. These findings suggest an important role for CMR in surgical decision making in degenerative MR. (Comparison Study of Echocardiography and Cardiovascular Magnetic Resonance Imaging in the Assessment of Mitral and Aortic Regurgitation; NCT04038879).
本研究旨在比较美国超声心动图学会（ASE）评估二尖瓣反流（MR）的算法与二尖瓣介入治疗后心脏磁共振（CMR）和左心室（LV）重构。
ASE 推荐整合多种超声心动图参数来评估 MR。ASE 指南包括一个算法，该算法对参数进行加权，并突出那些被认为表明肯定轻度或肯定重度 MR 的参数。
我们前瞻性纳入了 152 名（年龄 62±13 岁；59%为男性）退行性 MR 患者，他们接受了 ASE 算法指导的超声心动图和 CMR 分级评估 MR 严重程度。根据 ASE 算法，患者被分为肯定轻度、I 级、II 级、III 级、IV 级或肯定重度 MR。CMR MR 容积被分为轻度（<30mL）、中度 II 级（30-44mL）、中度 III 级（45-59mL）或重度（≥60mL）。其中 63 名患者接受了成功的二尖瓣介入治疗，其中 48 名患者在介入治疗后接受了 CMR。
仅 52%的 ASE 算法中肯定重度 MR 的患者 CMR 显示重度 MR，10%的患者 CMR 显示轻度 MR。CMR 显示随着 MR 严重程度的增加，二尖瓣介入治疗后 LV 逆重构增加（P<0.0001），而 ASE 算法则没有（P=0.07）。CMR 重度 MR 是二尖瓣介入治疗后 LV 逆重构的独立预测因子，而 ASE 算法中的重度 MR 则不是。
在退行性 MR 患者中，CMR 与 ASE 算法之间的一致性并不理想。CMR 重度 MR 是二尖瓣介入治疗后 LV 逆重构的独立预测因子，而 ASE 算法中的重度 MR 则不是。这些发现表明 CMR 在退行性 MR 的手术决策中具有重要作用。（超声心动图和心血管磁共振成像在评估二尖瓣和主动脉瓣反流中的比较研究；NCT04038879）。
