Elsevier

JACC: Cardiovascular Imaging

Volume 3, Issue 10, October 2010, Pages 1037-1045
JACC: Cardiovascular Imaging

Original Research
CMR Predictors of Mitral Regurgitation in Mitral Valve Prolapse

https://doi.org/10.1016/j.jcmg.2010.06.016Get rights and content
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Objectives

We sought to assess the correlation between mitral valve characteristics and severity of mitral regurgitation (MR) in subjects with mitral valve prolapse (MVP) undergoing cardiac magnetic resonance (CMR) imaging.

Background

Compared with extensive echocardiographic studies, CMR predictors of MVP-related MR are unknown. The severity of MR at the time of diagnosis has prognostic implication for patients; therefore, the identification of determinants of MR and its progression may be important for risk stratification, follow-up recommendations, and surgical decision making.

Methods

Seventy-one MVP patients (age 54 ± 11 years, 58% males, left ventricular [LV] ejection fraction 65 ± 5%) underwent cine CMR to assess annular dimensions, maximum systolic anterior and posterior leaflet displacement, papillary muscle (PM) distance to coaptation point and prolapsed leaflets, as well as diastolic anterior and posterior leaflet thickness and length, and LV volumes and mass. Velocity-encoded CMR was used to obtain aortic outflow and to quantify MR volume.

Results

Using multiple linear regression analysis including all variables, LV mass (p < 0.001), anterior leaflet length (p = 0.006), and posterior displacement (p = 0.01) were the best determinants of MR volume with a model-adjusted R2 = 0.6. When the analysis was restricted to valvular characteristics, MR volume correlated with anterior mitral leaflet length (p < 0.001), posterior mitral leaflet displacement (p = 0.003), posterior leaflet thickness (p = 0.008), and the presence of flail (p = 0.005) with a model-adjusted R2 = 0.5. We also demonstrated acceptable intraobserver and interobserver variability in these measurements.

Conclusions

Anterior leaflet length, posterior leaflet displacement, posterior leaflet thickness, and the presence of flail are the best CMR valvular determinants of MVP-related MR. The acceptable intraobserver and interobserver variability of our measurements confirms the role of CMR as an imaging modality for assessment of MVP patients with significant MR.

Key Words

mitral regurgitation
mitral valve prolapse
valvular characteristics

Abbreviations and Acronyms

CMR
cardiac magnetic resonance
LV
left ventricle/ventricular
MR
mitral regurgitation
MVP
mitral valve prolapse
PM
papillary muscle

Cited by (0)

Dr. Han has received grant support from the American College of Cardiology Foundation and Beth Israel Deaconess Medical Center and the Clinical Investigator Training Program: Beth Israel Deaconess Medical Center–Harvard/MIT Health Sciences and Technology, in collaboration with Pfizer Inc. and Merck & Co. All authors have reported that they have no relationships to disclose.