Determination of Clinical Outcome in Mitral Regurgitation With Cardiovascular Magnetic Resonance Quantification

Circulation. 2016 Jun 7;133(23):2287-96. doi: 10.1161/CIRCULATIONAHA.115.017888. Epub 2016 May 17.

Abstract

Background: Surgery for severe mitral regurgitation is indicated if symptoms or left ventricular dilation or dysfunction occur. However, prognosis is already reduced by this stage, and earlier surgery on asymptomatic patients has been advocated if valve repair is likely, but identifying suitable patients for early surgery is difficult. Quantifying the regurgitation may help, but evidence for its link with outcome is limited. Cardiovascular magnetic resonance (CMR) can accurately quantify mitral regurgitation, and we examined whether this was associated with the future need for surgery.

Methods and results: One hundred nine asymptomatic patients with echocardiographic moderate or severe mitral regurgitation had baseline CMR scans and were followed up for up to 8 years (mean, 2.5±1.9 years). CMR quantification accurately identified patients who progressed to symptoms or other indications for surgery: 91% of subjects with regurgitant volume ≤55 mL survived to 5 years without surgery compared with only 21% with regurgitant volume >55 mL (P<0.0001). A similar separation was observed for regurgitant fraction ≤40% and >40%. CMR-derived end-diastolic volume index showed a weaker association with outcome (proportions surviving without surgery at 5 years, 90% for left ventricular end-diastolic volume index <100 mL/m(2) versus 48% for ≥100 mL/m(2)) and added little to the discriminatory power of regurgitant fraction/volume alone.

Conclusions: CMR quantification of mitral regurgitation was associated with the development of symptoms or other indications for surgery and showed better discriminatory ability than the reference-standard CMR-derived ventricular volumes. CMR may be able to identify appropriate patients for early surgery, with the potential to change clinical practice, although the clinical benefits of early surgery require confirmation in a clinical trial.

Keywords: magnetic resonance imaging; mitral valve; mitral valve insufficiency; outcome assessment (health care); prognosis.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Area Under Curve
  • Cardiac Surgical Procedures
  • Disease Progression
  • Disease-Free Survival
  • Echocardiography
  • England
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Middle Aged
  • Mitral Valve / diagnostic imaging*
  • Mitral Valve / physiopathology
  • Mitral Valve / surgery
  • Mitral Valve Insufficiency / diagnostic imaging*
  • Mitral Valve Insufficiency / mortality
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery
  • New Zealand
  • Patient Selection
  • Predictive Value of Tests
  • ROC Curve
  • Severity of Illness Index
  • Time Factors