title: Severe mitral regurgitation-relations between magnetic resonance imaging, echocardiography and natriuretic peptides.
abstract: BACKGROUND
  Assessment of the severity of mitral regurgitation by echocardiography can be technically demanding in certain patients and supplementary methods are therefore desirable. This study addressed the agreement between magnetic resonance imaging (MRI) and echocardiography, and their relations to natriuretic peptides (NT-proANP and NT-proBNP), in quantifying severe mitral regurgitation.
  
  
  METHODS
  Eighteen patients with severe mitral regurgitation scheduled for surgery underwent MRI, echocardiography and assay of natriuretic peptides preoperatively for clinical assessment.
  
  
  RESULTS
  MRI and echocardiography were comparable in measuring severity of regurgitation qualitatively but not quantitatively, mitral regurgitant fraction (mean difference 27.5 (11) ml). There was a correlation between increasing regurgitant fraction on MRI and increased levels of plasma NT-proANP and NT-proBNP. In echocardiography, increasing vena contracta width and increasing PISA correlated to increased levels of plasma NT-proANP and NT-proBNP. No other correlation was found between measures on MRI and echocardiography and natriuretic peptides.
  
  
  CONCLUSIONS
  MRI and echocardiography were comparable grading the severity of mitral regurgitation with qualitative measures but not with quantitative measures. MRI might be a complement to echocardiography when a more distinct measure of the regurgitant volume is needed, as in paravalvular leakage.
authors.affiliation: Department of Cardiothoracic Surgery, University Hospital, Uppsala, Sweden. laila.hellgren.johansson@akademiska.se
authors.forename: Laila
authors.initials: L
authors.lastname: Hellgren
authors.forename: Johan
authors.initials: J
authors.lastname: Landelius
authors.forename: Mats
authors.initials: M
authors.lastname: Stridsberg
authors.forename: Per
authors.initials: P
authors.lastname: Kvidal
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Ståhle
authors.forename: Tomas
authors.initials: T
authors.lastname: Bjerner
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000473:pathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012107:Research Design; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor