Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK.
Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK.
Med Sci (Basel). 2023 Jan 24;11(1):13. doi: 10.3390/medsci11010013.
There remains a debate whether the ventricular volume within prolapsing mitral valve (MV) leaflets should be included in the left ventricular (LV) end-systolic volume, and therefore factored in LV stroke volume (SV), in cardiac magnetic resonance (CMR) assessments. This study aims to compare LV volumes during end-systolic phases, with and without the inclusion of the volume of blood on the left atrial aspect of the atrioventricular groove but still within the MV prolapsing leaflets, against the reference LV SV by four-dimensional flow (4DF). A total of 15 patients with MV prolapse (MVP) were retrospectively enrolled in this study. We compared LV SV with (LV SV) and without (LV SV) MVP left ventricular doming volume, using 4D flow (LV SV) as the reference value. Significant differences were observed when comparing LV SV and LV SV ( < 0.001), and between LV SV and LV SV ( = 0.02). The Intraclass Correlation Coefficient (ICC) test demonstrated good repeatability between LV SV and LV SV (ICC = 0.86, < 0.001) but only moderate repeatability between LV SV and LV SV (ICC = 0.75, < 0.01). Calculating LV SV by including the MVP left ventricular doming volume has a higher consistency with LV SV derived from the 4DF assessment. In conclusion, LV SV short-axis cine assessment incorporating MVP dooming volume can significantly improve the precision of LV SV assessment compared to the reference 4DF method. Hence, in cases with bi-leaflet MVP, we recommend factoring in MVP dooming into the left ventricular end-systolic volume to improve the accuracy and precision of quantifying mitral regurgitation.
对于脱垂二尖瓣（MV）瓣叶内的心室容积是否应包含在左心室（LV）收缩末期容积中，并因此包含在 LV stroke volume（SV）中，心脏磁共振（CMR）评估中仍存在争议。本研究旨在比较收缩末期阶段的 LV 容积，包括和不包括 MV 脱垂瓣叶左心房面房室沟内的血液量，但仍包含在 MV 脱垂瓣叶内，与四维流（4DF）的参考 LV SV 进行比较。本研究共回顾性纳入 15 例 MV 脱垂（MVP）患者。我们比较了包含（LV SV）和不包含（LV SV）MVP 左心室隆凸容积的 LV SV，以 4D 流（LV SV）作为参考值。比较 LV SV 和 LV SV（<0.001）以及 LV SV 和 LV SV（=0.02）时，观察到显著差异。组内相关系数（ICC）检验显示 LV SV 和 LV SV（ICC=0.86，<0.001）之间具有良好的可重复性，但 LV SV 和 LV SV（ICC=0.75，<0.01）之间仅具有中度可重复性。通过包含 MVP 左心室隆凸容积计算 LV SV 与基于 4DF 评估的 LV SV 具有更高的一致性。总之，与参考 4DF 方法相比，纳入 MVP 脱垂容积的 LV SV 短轴电影评估可显著提高 LV SV 评估的精度。因此，在双瓣叶 MVP 病例中，我们建议将 MVP 脱垂纳入左心室收缩末期容积，以提高二尖瓣反流的定量准确性和精确性。
