title: Prognostic value of delayed enhancement cardiac magnetic resonance imaging in mitral valve repair.
abstract: BACKGROUND
  The objective of this study was to examine the prognostic utility of cardiac magnetic resonance imaging (CMR) in patients with chronic mitral regurgitation undergoing mitral valve repair.
  
  
  METHODS
  This study is a prospectively enrolled observational cohort study of 48 consecutive patients with chronic mitral regurgitation who had preoperative evaluation with CMR including delayed-enhancement CMR for assessment of myocardial fibrosis before undergoing mitral valve repair. Postoperative adverse clinical events were defined as intensive care unit readmission, needs of permanent cardiac pacemaker, and rehospitalization for cardiac reasons.
  
  
  RESULTS
  The cohort comprised 33 (69%) men with a mean age of 61±13 years and mean left ventricular ejection fraction of 0.63±0.12. Preoperative myocardial fibrosis was detected in 40% of the patients. Median fibrosis was 4% (interquartile range, 2% to 10%). Mean follow-up duration was 11 months (interquartile range, 1 to 24 months). Adverse clinical events occurred in 16 patients. In multivariate analysis, the presence of myocardial fibrosis was independently associated with postoperative adverse clinical events (hazard ratio, 4.775; 95% confidence interval, 1.100 to 20.729; p=0.037). The addition of the presence of myocardial fibrosis to the preoperative characteristics model significantly improved overall predictive performance (p=0.04).
  
  
  CONCLUSIONS
  The presence of preoperative myocardial fibrosis assessed with delayed-enhancement CMR was an independent predictor of increased adverse clinical outcomes in patients with chronic mitral regurgitation undergoing mitral valve repair. Our findings suggest that in this population, preoperative delayed-enhancement CMR may be of clinical utility.
authors.affiliation: Department of Medicine, Houston Methodist Hospital, Houston, Texas.
authors.forename: Kongkiat
authors.initials: K
authors.lastname: Chaikriangkrai
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Lopez-Mattei
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Gerald
authors.initials: G
authors.lastname: Lawrie
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Homam
authors.initials: H
authors.lastname: Ibrahim
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Quinones
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: William
authors.initials: W
authors.lastname: Zoghbi
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Little
authors.affiliation: Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas. Electronic address: djshah@houstonmethodist.org.
authors.forename: Dipan J
authors.initials: DJ
authors.lastname: Shah
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000601:surgery; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome