title: Cardiovascular magnetic resonance imaging-derived mitral valve geometry in determining mitral regurgitation severity.
abstract: BACKGROUND
  Mitral regurgitation is the most common valvular heart disease worldwide. Magnetic resonance may be a useful tool to analyze mitral valve parameters.
  
  
  OBJECTIVE
  To distinguish mitral valve geometric patterns in patients with different severities of mitral regurgitation (MR) based on cardiovascular magnetic resonance imaging.
  
  
  METHODS
  Sixty-three patients underwent cardiovascular magnetic resonance imaging. Mitral valve parameters analyzed were: tenting area (mm2) and angle (degrees), ventricle height (mm), tenting height (mm), anterior leaflet, posterior leaflet length and annulus diameter (mm). Patients were divided into two groups, one including patients who required mitral valve surgery and another which did not.
  
  
  RESULTS
  Thirty-six patients had trace to mild (1-2+) MR and 27 had moderate to severe MR (3-4+). Ten (15.9%) out of 63 patients underwent surgery. Patients with more severe MR had a larger left ventricle end systolic diameter (38.6 ± 10.2 vs 45.4 ± 16.8, p<0.05) and left end diastolic diameter (52.9 ± 6.8 vs 60.1 ± 12.3, p= 0.005). On multivariate analysis, the tenting area was the strongest determinant of MR severity (r= 0.62, p=0.035). Annulus length (36.1 ± 4.7 vs 41 ± 6.7, p< 0.001), tenting area (190.7 ± 149.7 vs 130 ± 71.3, p= 0.048) and posterior leaflet length (15.1 ± 4.1 vs 12.2 ± 3.5, p= 0.023) were larger on patients requiring mitral valve surgery.
  
  
  CONCLUSIONS
  Tenting area, annulus and posterior leaflet length are possible determinants of MR severity. These geometric parameters could be used to determine severity and could, in the future, direct specific patient care based on individual mitral apparatus anatomy.
authors: Division of Cardiology, Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, PA, USA. andremsf@cardiol.br
authors: Andre Mauricio
authors: AM
authors: Fernandes
authors: Vikas
authors: V
authors: Rathi
authors: Robert W
authors: RW
authors: Biederman
authors: Mark
authors: M
authors: Doyle
authors: June A
authors: JA
authors: Yamrozik
authors: Ronald B
authors: RB
authors: Willians
authors: Vinayak
authors: V
authors: Hedge
authors: Saundra
authors: S
authors: Graunt
authors: Roque
authors: R
authors: Aras
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D009929:Organ Size; D011237:Predictive Value of Tests; D011379:Prognosis; D012016:Reference Values; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric